Assessing the present state and potential of medicaid controlled substance lock-in programs

Journal of Managed Care Pharmacy

Volumn 20, Issue 5, 2014, Pages 439-446

  Roberts, Andrew W ^a   Skinner, Asheley Cockrell ^b  

^a UNC Hamner Institute for Drug Safety Sciences   (United States)

^b UNIVERSITY OF NORTH CAROLINA SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CONTROLLED SUBSTANCE; PRESCRIPTION DRUG;

ARTICLE; COST CONTROL; DRUG SEEKING BEHAVIOR; HEALTH CARE PERSONNEL; HEALTH CARE POLICY; HEALTH PROGRAM; HUMAN; MEDICAID; PHARMACY; PRESCRIPTION; PROGRAM EFFECTIVENESS; PROGRAM EVALUATION; PROGRAM IMPACT; SUBSTANCE USE; DRUG CONTROL; HEALTH CARE DELIVERY; HOSPITAL PLANNING; LEGISLATION AND JURISPRUDENCE; PSYCHOLOGY; SUBSTANCE-RELATED DISORDERS; SUPPLY AND DISTRIBUTION; UNITED STATES; HIGH RISK POPULATION; OUTCOME ASSESSMENT;

COMMUNITY PHARMACY SERVICES; CONTROLLED SUBSTANCES; DELIVERY OF HEALTH CARE; DRUG AND NARCOTIC CONTROL; DRUG-SEEKING BEHAVIOR; HEALTH POLICY; HOSPITAL PLANNING; HUMANS; MEDICAID; PRESCRIPTION DRUGS; PROGRAM EVALUATION; SUBSTANCE-RELATED DISORDERS; UNITED STATES;

EID: 84898995780     PISSN: 10834087     EISSN: None     Source Type: Journal    
DOI: 10.18553/jmcp.2014.20.5.439     Document Type: Article

References (51)

1. Hertz JA, Knight JR. Prescription drug misuse: a growing national problem. Adolesc Med Clin. 2006;17(3):751-69.
2. Substance Abuse and Mental Health Services Administration. Office of Applied Studies. The NSDUH report: trends in nonmedical use of prescription pain relievers: 2002 to 2007. February 5, 2009. Rockville, MD. Available at: http://www.samhsa.gov/data/2k9/painRelievers/nonmedical-Trends.htm. Accessed January 25, 2014.
3. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. Results from the 2011 National Survey on Drug Use and Health: summary of national findings. NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. Available at: http://www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresults2011.htm. Accessed January 25, 2014.
4. Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality. Highlights of the 2010 Drug Abuse Warning Network (DAWN): Findings on drug-related emergency department visits. July 2, 2012. Rockville, MD. Available at: http://www.samhsa.gov/data/2k12/DAWN096/SR096EDHighlights2010.pdf. Accessed January 25, 2014.
5. Centers for Disease Control and Prevention. Prescription painkiller overdoses in the US. November 2011. Available at: http://www.cdc.gov/vitalsigns/painkilleroverdoses/. Accessed January 25, 2014.
6. Centers for Disease Control and Prevention. Unintentional drug poisoning in the United States. July 2010. Available at: http://www.cdc.gov/homeandrecreationalsafety/pdf/poison-issue-brief.pdf. Accessed January 25, 2014.
7. Centers for Disease Control and Prevention. Vital signs: overdoses of prescription opioid pain relievers-United States, 1999-2008. MMWR Morb Mortal Wkly Rep. 2011;60(43):1487-92.
8. Ghate SR, Haroutiunian S, Winslow R, McAdam-Marx C. Cost and comorbidities associated with opioid abuse in managed care and Medicaid patients in the United States: a comparison of two recently published studies. J Pain Palliat Care Pharmacother. 2010;24(3):251-58.
9. Hansen RN, Oster G, Edelsberg J, Woody GE, Sullivan SD. Economic costs of nonmedical use of prescription opioids. Clin J Pain. 2011;27(3):194-202.
10. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based injury statistics query and reporting system (WISQARS). Updated November 19, 2013. Available at: http://www.cdc.gov/injury/wisqars/. Accessed January 25, 2014.
11. Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305(13):1315-21.
12. Becker WC, Tobin DG, Fiellin DA. Nonmedical use of opioid analgesics obtained directly from physicians: prevalence and correlates. Arch Intern Med. 2011;171(11):1034-36.
13. Buck JA, Silverman HA. Use of utilization management methods in state Medicaid programs. Health Care Financ Rev. 1996;17(4):77-86.
14. Ross-Degnan D, Simoni-Wastila L, Brown JS, et al. A controlled study of the effects of state surveillance on indicators of problematic and nonproblematic benzodiazepine use in a Medicaid population. Int J Psychiatry Med. 2004;34(2):103-23.
15. Executive Office of the President of the United States. Epidemic: responding to America's prescription drug abuse crisis. 2011. Available at: http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf. Accessed January 26, 2014.
16. National Alliance for Model State Drug Laws. Compilation of state prescription monitoring program maps (as of December 2012). 2013. Available at: http://www.namsdl.org/library/2B0930D1-1372-636C-DD48B345F-4D8ADCB/. Accessed January 26, 2014.
17. Reifler LM, Droz D, Bailey JE, et al. Do prescription monitoring programs impact state trends in opioid abuse/misuse? Pain Med. 2012;13(3):434-42.
18. Baehren DF, Marco CA, Droz DE, Sinha S, Callan EM, Akpunonu P. A statewide prescription monitoring program affects emergency department prescribing behaviors. Ann Emerg Med. 2010;56(1):19-23.
19. Paulozzi LJ, Kilbourne EM, Desai HA. Prescription drug monitoring programs and death rates from drug overdose. Pain Med. 2011;12(5):747-54.
20. Feldman L, Williams KS, Coates J, Knox M. Awareness and utilization of a prescription monitoring program among physicians. J Pain Palliat Care Pharmacother. 2011;25(4):313-17.
21. Brandeis University PMP Center of Excellence. Trends in Wyoming PMP prescription history reporting: evidence for a decrease in doctor shopping? September 2010. Available at: http://www.pdmpexcellence.org/sites/all/pdfs/NFF_wyoming_whole.pdf. Accessed January 27, 2014.
22. Exceptions to certain state plan requirements, 42 CFR 431.54. October 1, 2011. Available at: http://www.gpo.gov/fdsys/granule/CFR-2011-title42-vol4/CFR-2011-title42-vol4-sec431-54/content-detail.html. Accessed February 7, 2014.
23. Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008;300(22):2613-20.
24. Peirce GL, Smith MJ, Abate MA, Halverson J. Doctor and pharmacy shopping for controlled substances. Med Care. 2012;50(6):494-500.
25. U.S. Department of Justice. National Drug Intelligence Center. National drug threat assessment 2011. August 2011. Product No. 2011-Q0317-001. Available at: http://www.justice.gov/archive/ndic/pubs44/44849/44849p.pdf. Accessed January 27, 2014.
26. Cummings SM, Merlo L, Cottler L. Mechanisms of prescription drug diversion among impaired physicians. J Addict Dis. 2011;30(3):195-202.
27. Centers for Disease Control and Prevention. Overdose deaths involving prescription opioids among Medicaid enrollees-Washington, 2004-2007. MMWR Morb Mortal Wkly Rep. 2009;58(42):1171-75.
28. Florida Agency for Health Care Administration. Pharmacy lock-in program. Available at: http://www.fdhc.state.fl.us/Medicaid/Prescribed_Drug/lockin.shtml. Accessed January 27, 2014.
29. Missouri Department of Social Services. Rules of Department of Social Services. 13 CSR 70-4.070: Title XIX recipient lock-in program. May 31, 2012. Available at: http://www.sos.mo.gov/adrules/csr/current/13csr/13c70-4.pdf. Accessed January 27, 2014.
30. Nebraska Department of Health and Human Services. Nebraska HHS finance and support manual. 471 NAC 2-004. Client lock-in. Revised July 7, 1998. Available at: http://www.sos.ne.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-02.pdf. Accessed January 27, 2014.
31. State of New Jersey. Office of the State Comptroller. Medicaid fraud division workplan: fiscal year 2011. 2011:39-41. Available at: http://nj.gov/njomig/documents/Workplan%202011%20Final%20No%20Cover.pdf. Accessed January 27, 2014.
32. Pennsylvania Department of Public Welfare. Pennsylvania PROMISe provider handbook. January 2014. Available at: http://www.dpw.state.pa.us/cs/groups/webcontent/documents/document/s_001851.pdf. Accessed February 13, 2014.
33. Nevada Medicaid. Web announcement 228: pharmacy lock-in program implemented. November 14, 2008. Available at: http://www.medicaid.nv.gov/Downloads/provider/web_announcement_228_111408.pdf. Accessed January 27, 2014.
34. Magellan Medicaid Administration. Lock-in overview. Idaho DUR Quarterly. 2011;1(1):2. Available at: http://www.healthandwelfare.idaho.gov/Portals/0/Medical/PrescriptionDrugs/DUR%20Newsletter%20Feb%202011. pdf. Accessed January 27, 2014.
35. State of Virginia. 12VAC30-130-810. Client medical management program for recipients. Amended March 4, 1998. Available at: http://leg1.state.va.us/cgibin/legp504.exe?000+reg+12VAC30-130-810. Accessed January 27, 2014.
36. Blake SG Feldhaus JF, Hunter TS, Rappaport H, Holt G, Medon PJ. PMD2 the effect of the Louisiana Medicaid lock-in on prescription drug utilization and expenditures. Value in Health. 1998;1(1):72.
37. Mitchell L. Pharmacy lock-in program promotes appropriate use of resources. J Okla State Med Assoc. 2009;102(8):276.
38. Mailloux AT, Cummings SW, Mugdh M. A decision support tool for identifying abuse of controlled substances by ForwardHealth Medicaid members. J Hosp Mark Public Relations. 2010;20(1):34-55.
39. Connecticut Medical Assistance Pharmacy Program. Drug Utilization Review Program. DUR board meeting minutes. June 10, 2010. Available at: https://www.ctdssmap.com/CTPortal/Portals/0/StaticContent/Publications/June_10_Minutes.pdf. Accessed January 27, 2014.
40. Connecticut Medical Assistance Pharmacy Program. Drug Utilization Review Program. DUR board meeting minutes. June 14, 2012. Available at: https://www.ctdssmap.com/CTPortal/Portals/0/StaticContent/Publications/June_12_Minutes.pdf. Accessed January 27, 2014.
41. Colbourn D, Coady J, Ellis A, Griffin H, Tripp M. Medicaid integrity program: Iowa comprehensive program integrity review. Final report. Centers for Medicare&Medicaid Services. November 2008. Available at: http://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/FraudAbuseforProfs/downloads/iacompfy08pireviewfinalreport.pdf. Accessed January 27, 2014.
42. Heitshusen S. Lock in: locking out Medicaid abuse. WHOtv.com. Des Moines, Iowa. June 21, 2012. Available at: http://whotv.com/2012/06/21/lock-in-locking-out-medicaid-abuse/. Accessed January 27, 2014.
43. North Carolina Department of Health and Human Services. 2.3 million pills off the streets, $5.2 million saved by narcotics lock-in. May 14, 2012. Available at: http://www.ncdhhs.gov/pressrel/2012/2012-05-14_pills_off_ streets.htm. Accessed January 27, 2014.
44. Coolen P. Patient review and coordination program for medical assistance clients who need assistance in appropriate use of services. Washington Department of Health and Social Services. January 2009. Available at: http://www.safestates.org/associations/5805/files/Patient%20Review%20Coordination%20program6.pdf. Accessed January 27, 2014.
45. Centers for Medicare&Medicaid Services. Drug diversion in the Medicaid program: state strategies for reducing prescription drug diversion in Medicaid. January 2012. Available at: http://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/MedicaidIntegrityProgram/downloads/drugdiversion.pdf. Accessed January 27, 2014.
46. Braker LS, Reese AE, Card RO, Van Howe RS. Screening for potential prescription opioid misuse in a Michigan Medicaid population. Fam Med. 2009;41(10):729-34.
47. Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85-92.
48. Rice JB, White AG, Birnbaum HG, Schiller M, Brown DA, Roland CL. A model to identify patients at risk for prescription opioid abuse, dependence, and misuse. Pain Med. 2012;13(9):1162-73.
49. Sehgal N, Manchikanti L, Smith HS. Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse. Pain Physician. 2012;15(3 Suppl):ES67-92.
50. Montana Department of Public Health and Human Services. Team care handbook. June 2010. Available at: http://medicaidprovider.hhs.mt.gov/pdf/teamcarehandbook.pdf. Accessed January 27, 2014.
51. Deyo RA, Irvine JM, Millet LM, et al. Measures such as interstate cooperation would improve the efficacy of programs to track controlled drug prescriptions. Health Aff (Millwood). 2013;32(3):603-13.