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Institute for Population Health Improvement

Institute for Population Health Improvement

Opiate Over Rx Report

Many assert that effective policies aimed at preventing the increasing abuse of prescription opioids among Medicaid beneficiaries could save tens of millions of dollars by substantially reducing associated mortality, morbidity and associated healthcare costs. However, the lack of cost-effectiveness data gives rise to the need for evidence-based investigations. This report presents the design and findings of a micro-simulation model that evaluates how certain policies might reduce the misuse/abuse of prescription opioids in the Medicaid population, thus reducing associated, preventable health care costs and outcomes. Use of illegal opioids (e.g., heroin), prescriber fraud, and opioid diversion fall outside the scope of this project.

We developed this model in response to a CDC request to examine the effectiveness of Medicaid patient review and restriction programs (PRR), sometimes referred to as patient “lock-in” programs. The Approaches to Drug Overdose Prevention Analytical Tool (ADOPT) is an evidence-based tool to help inform policy decisions regarding prescription drug overdose prevention policies. This micro-simulation model simulates the prescription opioid behavior of an adult Medicaid enrollee cohort to explore the impact and the cost-effectiveness of such programs. By applying various PRR policies to the simulated prescription opioid behavior, users can assess the cost and health impacts of the policies. ADOPT supports interactive features that allow users to customize the population demographics and policy details, and performs a "what-if" analysis to project the outcomes of a specified policy within that population. Although ADOPT has the potential to analyze and compare different approaches to opioid overdose/abuse prevention (such as prescriber/patient education or monitoring strategies), the current version focuses on the Medicaid patient review and restriction (PRR) program. The model was informed by an analysis of a MarketScan® Medicaid dataset and a literature review.

 Click here to view the report.