105 Measuring Quality of Initial Opioid Prescribing: Pilot Testing Results for Pharmacy Quality Alliance in Medicaid, Medicare and Commercially Insured Patients Ranna Ardebili1, Olivia Letzkus1, Holly Little1, Barbara Tschirpke1, Maithili Rao1, Meridith Blevins Peratikos1,2, Stacey Grant1, Elizabeth Ann Stringer1 axialHealthcare, Nashville, Tennessee, USA. 2Vanderbilt University Medical Center, Department of Biostatistics, Nashville, Tennessee, USA 1
Purpose One of the most commonly prescribed analgesic drugs for alleviating or controlling pain is an opioid. Opiates have formally been approved for analgesia for close to 70 years, with the assumption that this class of medication is relatively safe. Meanwhile, the escalating rates of opioid abuse and overdose have raised concern about the safety of these drugs. The U.S. is in the midst of a major public health challenge: increased prescriptions of opioid medications have led to a widespread misuse, leading to an opioid crisis. In 2016, 11.1 million people reported misusing prescription opioids and more than 42,000 deaths were attributable to opioid overdoses, 40% of which were a result of an opioid prescription. To prevent the adverse risks associated with opioid consumption, providers should prescribe opioids only when necessary, in the lowest effective dose and for the shortest duration. In response to the demand for judicious opioid prescribing, Pharmacy Quality Alliance (PQA) drafted three measures to retrospectively assess health plan performance for initial opioid prescriptions, including: 1) long duration, 2) high dosage, and 3) extended-release opioids. Each of the performance measures have been shown as significant predictors of continued opioid use, which increases the risk for complications, including opioid use disorder and opioid overdose. This analysis describes results for pilot testing of PQA initial opioid prescribing measures across Medicare, Medicaid, and Commercial member populations. Methods We reviewed medical and pharmacy claims for more than 2.5 million members across three Medicare (328,311 members), opioid prescription fill between January 1 and December 31, 2017 who did not have a hospice or cancer indicator were eligible for inclusion in all three performance measures. Individuals included had continuous health plan enrollment during the measurement year and the 90 days prior to the index prescription start date (IPSD). The IPSD is the earliest date of service for an opioid medication during the measurement year. Initial opioid prescriptions were identified by the earliest date of service for an opioid prescription during the measurement year following a negative opioid history, where no opioid prescription was filled 90 days prior to the prescription fill date. Hospice or cancer exclusions were determined by the presence of at least one place of service or ICD-10-CM diagnosis code, respectively, during the measurement year and the 90 days prior to IPSD. Among members meeting criteria for initial opioid prescribing and eligibility, mean average and range were calculated across health plans for three metrics, including: long duration, high dosage, and extended-release opioids. Long duration was defined as any initial opioid -release or long acting opioid formulations of interest were defined by PQA guidelines. Opioids included in the evaluation of each metric were also provided by PQA and included all opioids with a MME conversion; buprenorphine, injectable formulations, and opioid cough and cold products were excluded. Results Quality measures were assessed for each of three Medicare, four Medicaid, and three Commercial health plans, with 274,261 total members meeting inclusion criteria (49,531 Medicare; 77,129 Medicaid; 147,601 Commercial). Percentages of members filling initial opioid prescriptions with long duration were: 48.6% in Medicare (range: 44.7% to 53.8%), 20.5% in Medicaid (9.5% to 29.5%), and 25.1% in Commercial (23.7% to 26.8%). Percentages of members filling initial opioid prescriptions at high dosage were: 13.7% in Medicare (12.2% to 15.6%), 18.2% in Medicaid (16.7% to 20.5%), and 19.4% in Commercial (18.8%