The effect of targeted insurer-mandated prescription monitoring on opioid prescribing patterns

Abstract

Objectives: The purpose of this study was to determine the impact of a mandate from 2 large insurers in South Carolina for mandatory review of the state's prescription drug monitoring program (PDMP) for controlled substance (CS) prescriptions for more than 5 days' supply on the proportion of opioid prescriptions for less than or equal to 5 days in a statewide adult population. In addition, changes in the mean morphine milligram equivalents (MME) per day for prescriptions for 5 days or less were described to evaluate prescribing changes.

Design, setting and participants: All prescriptions for opioids written for and filled by adults (≥ 18 years of age) and reported to the PDMP from January 1, 2010, to December 31, 2017, were included in an interrupted time series analysis.

Outcome measures: An interrupted time series analysis was performed to determine if there was a significant change in the proportion of opioid prescriptions for less than or equal to 5 days' supply.

Results: Overall opioid prescriptions decreased over the time period by 11.5%, including a decreasing rate of opioid prescriptions for less than or equal to 5 days' supply. There was no statistical difference in the slope between the pre- and postmandate cohorts (P = 0.077, r² = 0.951). There was not an identified corresponding increase in the MME per day of prescriptions.

Conclusion: Our analysis found that 2 major insurer mandates that occurred in South Carolina in 2016, which required a review of the state PDMP for CS prescriptions for more than 5 days' supply, did not have a significant impact on the proportion of opioid prescriptions for less than or equal to 5 days' supply in the statewide population. In addition, we did not find any concern that prescribers attempted to circumvent the requirement by inappropriately adjusting dosing instructions.