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 Pew Expert Says Multi-Pronged Effort is Key to Curbing Opioid Misuse

Patient Review and Restriction (PRR) programs are an integral part of an overall strategy by stakeholders to tackle the opioid abuse epidemic taking place across the nation, but regulatory changes and overall education are needed to make PRR efforts work effectively for Medicare and Medicaid beneficiaries, according to an expert in the field.

In a recent presentation before an America’s Health Insurance Plans conference, and in a subsequent talk with Provider, Cynthia Reilly, director of the substance use prevention and treatment initiative for The Pew Charitable Trusts, says PRRs are a staple of commercial health insurers and have expanded in use in the Medicaid program with the growth of managed care insurers’ Medicaid plans.

As for Medicare, in July 2016 language in the Comprehensive Addiction and Recovery Act (CARA) authorized use of PRR programs in Medicare, but regulations from the Centers for Medicare & Medicaid Services to allow implementation are still pending.

“These programs identify patients at risk for either harm or misuse of controlled substances. And in the long term care and Medicare populations, there is the risk of overdoses but also these populations can have other risks like falls from use of the medications,” Reilly says.

But even as efforts are underway to make the programs part of a prevention standard in the government reimbursement space—along with providing patients access to evidence-based treatment—gaps exist in caring for frail elders in the Medicaid population, whose beneficiaries are more likely than those with private health plans to experience harm from opioids.

Into this mix, Reilly says prevention efforts spearheaded by PRR programs are working to manage patients at risk for misuse of prescription drugs by tracking for those who receive large quantities or duplicative controlled substances. Pew lists some ways in which the programs can work for the greatest number of Medicare and Medicaid beneficiaries, including: finalizing Medicare regulations for PRRs in CARA and offering Medicaid PRR program enrollees additional services (like medication therapy management) to improve overall patient care.

“Pew’s PDMP [prescription drug monitoring program] work is focused on increasing prescriber use,” Reilly says, stressing that providers of all stripes see challenges in using the programs because of workflow issues based mainly on the amount of time needed to access their databases.

“Research highlights strategies that remove those barriers,” Reilly says. “They include putting information in the hands of providers to help them make better-informed prescribing decisions,” she says. And that information is now digestible for clinicians and administrators in easier-to-understand formats versus the older methods of reams of computer printouts with no discernible presentation on the most important trends, like medication use and prescribing patterns from multiple sources.

“Providers are receptive to PDMP programs,” Reilly says. “They may say at the start it was a burden based on time and all of that, but once prescribers view this information, they don’t want to have it taken away.”

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