Results of an article on prescription drug treatment for patients with low back pain in JAMA Network Open highlight opportunities for insurers and pharmacy benefit managers to alter the role of opioids for pain management, to expand alternatives to opioids through policies for coverage and reimbursement, and to measure the effect of these changes on patient outcomes.
Researchers performed a cross-sectional study of coverage polices from Medicaid, Medicare Advantage and commercial health plans in 2017 for 62 products used to treat low back pain. Of these products, 30 were prescription opioids and 32 were nonopioid analgesics. Investigators conducted a data analysis between April 2017 and January 2018 and assessed the main outcomes of formulary coverage, utilization management and patient out-of-pocket costs. Results showed Medicaid plans covered a median of 19 of the examined opioids and 22 nonopioids, while Medicare Advantage covered 17 opioids and 22 nonopioids. Investigators noted commercial plans covered more opioids and nonopioids, with 23 and 26, respectively. Strategies for use management were common for opioids in Medicaid, Medicare Advantage and commercial plans.
According to researchers, step therapy was uncommon. They found many nonopioids that were assessed underwent utilization management, particularly quality limits and prior authorization. For the commercial plans, investigators found median plans grouped 18 opioids and 20 nonopioids in tier 1. This correlated with a median out-of-pocket cost of $10 per 30-day supply.
“Key informant interviews revealed an emphasis on increasing opioid utilization management and identifying high-risk prescribers and patients, rather than promoting comprehensive strategies to improve treatment of chronic pain or better integrating pharmacologic and nonpharmacologic alternatives to opioids,” the researchers wrote. – by Monica Jaramillo
Disclosure: Burkus reports no relevant financial disclosures.