The Impact of Opioid Safety Edits on Opioid Utilization

Objective To evaluate the impact of opioid safety edits on opioid utilization. Design Retrospective review. Setting Senior Care Action Network (SCAN) Health Plan, a Medicare Advantage Prescription Drug Plan. Patients, Participants The opioid safety edits reviewed included edits for the following: initial opioid fill more than 7 days’ supply (DS), cumulative opioid doses 90 or greater and 240 or greater morphine milligram equivalent (MME), concurrent opioid and benzodiazepine (COB) use. Members with prescription drug claims meeting these criteria pre- and postedit implementation and those with prescription drug claim rejections resulting from the edits were included in the review. Results 15,232 members experienced claim rejections resulting from the edits. Comparison of utilization pre and postedit implementation revealed the following results (P < 0.001): 41% decrease in the proportion of members with an initial opioid fill for more than 7 DS; 18% decrease in the proportion of members on opioid doses 90 MME or more; 26% decrease in the proportion of members on opioid doses 240 MME or more; 18% decrease in the proportion of members with COB. Conclusion Opioid safety edits are an effective way to combat overuse and misuse. They serve as a means for increasing collaboration between plans, prescribers, pharmacists, and members which improves care coordination, reduces adverse risks, and helps keep members safe.

Associations of care experiences with survival among people with cancer in SEER-CAHPS, 2006 to 2017.

177 Background: A growing body of literature indicates associations between cancer care experiences and survival. Several studies suggest people with cancer who report worse care experiences have greater mortality. However, studies in general patient populations have found worse care experiences are associated with lower mortality. To our knowledge, no study has evaluated the relationship between care experiences and survival using a large, nationally representative sample of cancer patients. Methods: We used linked SEER cancer registry-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to identify people diagnosed 8/2006-12/2013 with one of the top ten solid tumor cancer sites with the highest mortality rates among those over age 65 (lung, colon, prostate, pancreas, breast, bladder, ovary, esophagus, kidney, or liver cancers). We included people who completed a survey between 6-24 months post-diagnosis and were continuously enrolled in Medicare A & B from ≤6 months pre-diagnosis through survey completion. CAHPS outcomes were ratings of Overall Care, Specialist Physician, Health Plan, and Prescription Drug Plan (PDP) and composite scores of Getting Needed Care. We used survey-weighted Cox proportional hazard models to compare those who gave lower (0-8) vs higher ratings (9-10), and lower (0-89) vs higher (90-100) scores. Results: We identified 2,403 eligible people. Mean survival was 46 months and 26% died by 5 years after diagnosis. In unadjusted models, lower Overall Care ratings were significantly associated with higher mortality (HR=1.25, p=.04), but this did not persist in the adjusted model. In contrast, lower ratings of PDP were significantly associated with lower mortality after covariate adjustment (HR=.63, p=.02). Conclusions: Except for PDP, survival was similar among those with worse vs better care experiences. People with better cancer prognoses may perceive worse services from their PDP compared to those with poorer prognoses. Future research examining mechanisms underlying this association may be warranted. [Table: see text]

Older Americans’ Preferences Between Lower Drug Prices and Prescription Drug Plan Choice, 2019

Objectives. To assess older Americans’ willingness to trade off the possibility of choosing or changing their prescription drug plan for lower drug spending. Methods. We used data from the Kaiser Family Foundation Health Tracking Poll on prescription drugs carried out in February 2019. This nationwide telephone survey oversampled participants aged 65 years and older who, when weighted, were representative of the US older adult population. Results. Older adults were strongly in favor of the government negotiating drug prices in Medicare Part D (82% support); 60% of older adults would trade off the possibility of choosing or switching their drug plan in favor of lower drug prices. All groups preferred lower spending over plan choice, but this preference was stronger among individuals who were in poorer health, had lower education and income, and found it very difficult to afford the drugs they needed. Conclusions. The results suggest that Medicare beneficiaries could support policies that limit plan choice, as long as drug prices actually decrease.