Proposed Opioid Pre-Authorization Policy in Utah

Public health graduate students at Brigham Young University conducted an HIA to analyze the potential health effects of a bill proposed in the Utah Legislature to require prescribers to get prior authorization from an insurer for any opioid prescription that exceeds 90-morphine equivalents; for benzodiazepines prescribed to patients already taking opioids; and for new chronic opioid prescriptions (i.e., longer than 10 days in duration). This requirement would apply only to private insurance plans over which the state has jurisdiction, plans covering state employees, Medicaid, and workers’ compensation. The HIA predicted that if passed, the bill would reduce opioid prescribing and addiction rates and overdose-related deaths in the state.

Findings

Highly likely impacts:

• Increased time and cost for prescribers.
• Higher patient stress and anxiety because of difficulty getting needed prescriptions.

Likely impacts:

• Modest decrease in prescription of opioids.
• Modest decrease in consumption of prescription opioids.
• Modest decrease in number of persons addicted.
• Increase in other substance misuse (heroin particularly).
• Increase in crime and incarceration.

Plausible but not well-supported impacts:

• Higher patient pain tolerance.
• Increased patient suicide.
• Decreased addition to prescription opioids.
• Increase in health care costs.
• Increased productivity costs for pain specialists.

Recommendations

To mitigate negative health outcomes, the study recommended that the policy be modified to exempt pain specialists, because although many of the prescriptions they write fall above the 90-morphine equivalent, they have special training in dealing with chronic pain and are more likely than other practitioners to prescribe opioids appropriately. This change also would help mitigate the significant increase in time and cost for pain specialists that would probably result from this policy. In addition, maintaining the pre-authorization requirement for general practitioners would probably increase patient referrals to pain specialists, helping to ensure that patients with chronic pain receive appropriate care. The HIA recommended that the Utah Legislature adopt the policy with this modification.