Evaluation of the Pennsylvania OxyContin® Intensified Intervention: Impact on drug and services utilization and expenditures

Jose J. Hernandez, RPh, MPH¹, Diane McNally, BSPharm, MS², Barbara Layne, RN³, Linda Simoni-Wastila, PhD⁴, and Ilene Zuckerman, PharmD⁴. (1) Department of Pharmaceutical Health Services Research, University of Maryland, 515 West Lombard Street, Room 272, Baltimore, MD 21201-1563, 410-706-1418, jhern001@umaryland.edu, (2) Center on Drugs and Public Policy, University of Maryland School of Pharmacy, 515 West Lombard Street, Baltimore, MD 21201, (3) Pennsylvania Medical Society, Center for Professional Drug Education, 777 East Park Drive, PO Box 8820, Harrisburg, PA 17105, (4) Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 515 West Lombard Street, Room 275, Baltimore, MD 21201

Background: A retrospective data analysis was performed using Pennsylvania Medicaid claims data from January 1, 2001 until January 31, 2003. A series of activities (including educational and administrative interventions) was developed to reduce the inappropriate use of OxyContin® among Medicaid fee-for-service recipients.

Methods: Descriptive trends analysis of administrative claims was used to assess utilization and reimbursement patterns for OxyContin® and other select narcotic analgesics, as well as other indicators of health care utilization, before, during, and after intervention implementation. In addition, linear regression coefficients were used to establish monthly changes in each of the studied variables.

Results: The number of OxyContin® tablets and the monthly average number of milligrams of OxyContin® per user decreased after the implementation of the interventions. The number of days where more than two concurrent strengths of OxyContin® were utilized decreased throughout the study period, but most markedly after the prior authorization intervention. The proportion of OxyContin® users with >3 tablets per day also began declining concurrent with the educational intervention, and then declined markedly after prior authorization. Fentanyl patch was the narcotic agent with the highest expenditures after the intervention period. The total number of pain related outpatient physician visits and total emergency department visits for chronic pain remained constant through the study period.

Discussion: This evaluation suggests that the intervention may have had a positive influence in reducing the total number of OxyContin® tablets dispensed, although use and expenditures of other narcotic analgesics increased.

Learning Objectives:

This project describes the implementation of a pharmaceutical prior authorization process to reduce over utilization of a pharmaceutical controlled substance, as well as the methods used to quantify the impact of the intervention on associated measures of utilization and expenditures. Participants of this session will get an insight on how to select, evaluate and analyze medical claims to achieve these goals. At the conclusion of the session, the participants will be able to

Identify pieces of information from claims data needed to construct a valid and reliable intervention; recognize which controlled substances in the pharmaceutical market are at higher probability of misuse, abuse and diversion; describe the prognosis of a controlled substance intervention in quality, utilization and costs of medical care; and get an insight on the annual expenditures saved by the implementation of these types of interventions.

Keywords: Drug Use Review, Drug Abuse

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Substance Abuse Prevention Programs Poster Session

The 132nd Annual Meeting (November 6-10, 2004) of APHA