A study published in the CDC’s Morbidity and Mortality Weekly Report aimed to determine whether a decline in methadone-related deaths was related to the Medicaid reimbursement policies designed to reduce methadone prescribing.
CDC researchers analyzed state mortality and health care data and preferred drug list (PDL) policies to compare the number of deaths involving methadone with the rate of prescribing methadone for pain, characterize variation in methadone prescribing among payers and states, and assess whether an association existed between state Medicaid reimbursement PDL policies and methadone overdose rates.
The researchers noted that methadone-related overdose deaths declined sharply from 2007-2014. During this time, prescriptions for methadone made up 0.85% of all opioid prescriptions for pain in the commercially insured and 1.1% in the Medicaid population.
Overall prescription opioid overdose death rates increased 300% from 1999 to 2014, and the rate of methadone overdose fatalities increased by 600% before declining by 39% in 2014.
State drug management practices and reimbursement policies such as PDLs, which are formal published lists of “preferred” specific prescription drug products by brand and generic names, appeared to affect methadone prescribing practices. Prescribing drugs from the “preferred list” helps facilitate faster reimbursement. ­
The researchers analyzed data from 3 states (Florida, North Carolina, and South Carolina), selected based on geographic proximity, variation in state PDL policies, and data availability.
Methadone overdose rates were similar in Florida (1.75 per 100,000 persons) and North Carolina (1.67 per 100,000 persons), but dropped significantly in South Carolina (0.81 per 100,000 persons). Both Florida and North Carolina include methadone as a preferred drug, whereas South Carolina does not. Despite the differences, the overall opioid overdose death rates in 2013 were similar for Florida and South Carolina.
The researchers concluded that drug utilization management policies such as PDL placement may help reduce methadone-related injuries and deaths. Pharmacy management strategies, such as prior authorization, quantity limits, and retrospective drug utilization review, in combination with adherence to clinical prescribing guidelines and prescription drug monitoring programs, could also be beneficial in reducing methadone overdoses.
Faul M, Bohm M, Alexander C. Methadone prescribing and overdose and the association with Medicaid preferred drug list policies – United States, 2007-2014. MMWR. 2017; 66(12);320-323.