Patients are Circumventing Provision of Controlled Substance Lock-in Programs

A new study conducted by researchers from Creighton University, in collaboration with colleagues from the University of North Carolina at Chapel Hill concludes that a significant loophole in a popular program for stemming opioid abuse may be limiting its effectiveness. Controlled substance lock-in requires patients who are identified as at risk for medication abuse to interact with a single prescriber and pharmacy to obtain coverage for their opioid medications. But an examination of Medicaid enrollees in North Carolina found that patients could, and were, circumventing the lock-in oversight by simply paying for their prescriptions out of pocket. The results were published last week in Health Affairs.

Andrew Roberts, PharmD, PhD, assistant professor of pharmacy sciences at Creighton University, observed, “Lock-in programs are really good at cost containment. But there are a lot of questions as to how useful they are in the prevention of opioid abuse.” Dr. Roberts and colleagues performed a retrospective study of 1,647 Medicaid program enrollees in North Carolina, and found that 55% were likely to purchase their opioids out of pocket at least once a month. This compared with a 16% probability for such purchases before the lock-in program restrictions. Thus, although the program served to reduce the number of Medicaid-covered claims for opioid prescriptions, the quadrupling of out of pocket purchases offset about one-half of that reduction. According to the authors, “This finding illuminates weaknesses of lock-in programs and highlights the need for further scrutiny of the appropriate role, optimal design, and potential unintended consequences of the programs as tools to prevent opioid abuse.”

A news story about the study findings may be read here.

The article abstract may be read here.

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