Prescription Practices/Third Party Payer
Virginia Medicaid implemented a number of interventions to limit opioid prescribing for pain management consistent with the Centers for Disease Control and Prevention (CDC) Opioid Prescribing Guideline. These include implementing evidence-based requirements for prior authorization requests and quantity limits for new opioid prescriptions in December 2016 in the Medicaid Fee-for-Service program, and across all the Medicaid Managed Care Organizations (MCOs) in July 2017. To encourage more substitution of nonopioid pain medications for opioids by providers, nonopioid pain medications that do not require prior authorization were added to all Medicaid MCO formularies. Virginia Medicaid convened a multi-stakeholder workgroup to advise on implementation of these new policies that included medical directors and pharmacy directors from all the Medicaid MCOs; leaders from state agencies, including the Department of Health Professions and Virginia Department of Health; representatives from the Medical Society of Virginia; and practicing physicians with expertise in chronic pain, addiction treatment, and primary care to advise on implementation of these new policies.
An independent evaluation by Virginia Commonwealth University demonstrated that prescriptions for opioid pain medications decreased by 27% while the number of unique patients receiving opioid medication decreased by only 17%. The results demonstrate that providers prescribed lower quantities and lower doses of opioids without large numbers of patients losing access. Virginia’s success implementing a multi-stakeholder and collaborative approach to address the opioid crisis demonstrates the value achieved by leveraging an engaged provider and payer community to deliver solutions that decrease the volume of opioids prescribed while preserving access to needed pharmacotherapy.
This session is accredited for the following accreditation types: CME, CNE, CPE, APA, AAFP, AAHCPAD*, NAADAC*, ASWB*
*State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.