HealthDay News — In an effort to restrict daily allowable prescribed dosing of prescription opioids, Medicare Part D formularies increasingly used quantity limits and prior authorization from 2006-2015, according to a research report published in the Annals of Internal Medicine.

Elizabeth A. Samuels, MD, MPH, from Yale University in New Haven, Connecticut, and colleagues used Centers for Medicare & Medicaid Services prescription drug plan formulary files to compare coverage in 2006, 2011, and 2015 for commonly used opioid medications except methadone.

The researchers found that more than two-thirds of drug-dosage combinations had no opioid prescribing restrictions in 2006 and 2011, while in 2015, about one-third had no restrictions. Step therapy was required by few formularies. There was an increase over time in the requirements for prior authorization (from a median of 0% in 2006 and 2011 to 4.4%in 2015). 

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There was also an increase in the median proportion of drug-dose combinations with quantity limits from 8.9% in 2006 to 22.2% in 2011 and 71.1% in 2015. There was an increase in dose restrictions to less than 50 morphine milligram equivalents per day from a median of 2.2% of drug-dose combinations in 2006 to 4.4% and 13.3% in 2011 and 2015, respectively.

“Because formulary coverage directly affects prescribing, our study suggests that formularies present an underused opportunity to restrict opioid prescribing,” the authors wrote.

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Samuels EA, Ross JS, Dhruva SS. Medicare formulary coverage restrictions for prescription opioids, 2006 to 2015 [published online October 10, 2017]. Ann Intern Med. doi:10.7326/M17-1823