Prescription drug abuse has become an epidemic, with 16,000 people dying in the United States each year from overdoses of prescription pain relievers. In 2011, the most recent year for which reliable data exist, nearly a quarter of a million Medicare beneficiaries took potentially life-threatening doses of these drugs for extended periods.
This epidemic is in part a consequence of disjointed medical care. Patients in pain often go to multiple doctors and pharmacies, making it difficult for any single provider to know if a patient is taking too much pain medication—and allowing some patients to obtain dangerous amounts of opioid drugs.
Fortunately, we know one way to solve this problem. Drug management protocols known as patient review and restriction programs (PRRs) allow state Medicaid and private insurance plans to make sure at-risk patients receive opioid prescriptions from only one doctor and fill them at only one pharmacy. The programs apply just to controlled substance prescriptions, and patients taking opioids as part of cancer treatment or hospice care are excluded. Patients work with their health plan to choose the one doctor who will prescribe their pain medications and the one pharmacy that will dispense them. And patients can choose different physicians and pharmacies for any medical needs other than their prescriptions for controlled substances.
The result is that the doctor and pharmacist improve care coordination and patients have access to the pain medication they need while lowering the risk of overdose.
Experts convened by the Centers for Disease Control and Prevention concluded in 2012 that PRRs have the potential to save lives and lower health care costs by reducing opioid use to safer levels. These programs have already yielded benefits for patients enrolled in them. In Oklahoma, Medicaid patients in a PRR program used fewer narcotic medications, decreased their visits to multiple pharmacies and physicians to obtain these drugs, and made fewer visits to emergency departments. Opioid doses were reduced by 40 percent for patients enrolled in the Ohio Medicaid PRR program.
The problem is that current federal law prevents Medicare from using PRRs. But there is significant bipartisan momentum building for change: the House Energy and Commerce Committee has included a bipartisan PRR provision as part of its 21st Century Cures initiative; the House Ways and Means Committee considered a similar bipartisan proposal; and the president has also signaled his support for the policy when he proposed establishing these programs in Medicare as part of his 2016 budget request to Congress.
With PRRs, we can give doctors and pharmacists the ability to better coordinate patient care. We can find those patients at risk of drug abuse. And we can address the unnecessary epidemic of deaths from prescription drug overdoses. These programs are a promising tool, but only if Congress grants Medicare the authority to use them. Our congressional leaders should work together to make that happen.
Cynthia Reilly directs The Pew Charitable Trusts’ prescription drug abuse project.