Impact of medicare part d opioid safety policies on disabled beneficiaries before and during the covid-19 pandemic
Active Project Grant Awarded Last action
- Award ID
- R01DA055131
- Recipient
-
Emory University UEI S352L5PJLMP8
- Awarding agency
-
National Institute on Drug Abuse
National Institutes of Health, Department of Health and Human Services
- Obligated
- $5,567,197
Award facts
- Assistance listing
- 93.279 Drug Use and Addiction Research Programs
- Completion date 86% complete
- Originally
- Place of performance
- Atlanta, GA 30322, USA
Award details come from USAspending.gov.
Description
- Abstract
- Representing ~3% of the U.S. Population, non-elderly disabled medicare beneficiaries (henceforth "disabled beneficiaries") account for ~25% of overdose deaths and hospitalizations related to prescription opioids. Among disabled beneficiaries, opioid-related harms are concentrated in the 20-25% who are prescribed long- term opioid therapy, primarily for chronic pain. We will first examine effects of a recent, important policy intervention - medicare part d opioid safety edits - on an understudied, high-risk cohort of disabled beneficiaries who are prescribed long-term, high-dose opioid therapy (aim 1). Effective january 1, 2019, medicare part d plans are required to incorporate a set of enhanced safety edits into their drug utilization review systems. The most salient is a "care coordination edit" alerting pharmacists when daily doses of opioid prescriptions exceed 90 morphine milligram equivalence. The new medicare part d opioid safety policy is intended to identify overprescribing through pharmacist-prescriber consultation without directly restricting patient access (intended beneficial effect). IT may also encourage the initiation of buprenorphine for opioid use disorder treatment in lieu of high-dose opioid regimes (beneficial spillover effect). However, the possible misinterpretation of the 90-MME threshold as a "hard stop", coupled with administrative burdens, may prompt rapid dose reduction and abrupt discontinuation (unintended detrimental effect). Furthermore, overrepresented among disabled beneficiaries, racial/ethnic minority patients and rural patients may be less likely to benefit from the medicare part d opioid safety policy and more susceptible to unintended harms (aim 2). The medicare part d opioid safety policy is now playing out against a backdrop of the covid-19 pandemic. To minimize potential disruptions to health care, the federal government has made temporary changes to the medicare telehealth and opioid regulations, which may facilitate the beneficial effects of the medicare part d opioid safety policy and alleviate the detrimental policy effects (aim 3). We will use 2017-22 medicare claims data and a quasi-experimental design. We will assess appropriate opioid tapering (intended beneficial effect), inappropriate opioid tapering (unintended detrimental effect), buprenorphine initiation (beneficial spillover effect), and opioid-related adverse events in emergency department and inpatient settings (downstream effect). We aim to: 1. Examine effects of the first-year, pre-pandemic implementation of the medicare part d opioid safety policy on disabled beneficiaries who are prescribed long-term, high-dose opioid therapy; 2. Compare racial/ethnic and rural-urban differences in policy effects; 3. Extend aims 1 and 2 to the pandemic and post-pandemic eras to elucidate the interaction of the medicare part d opioid safety policy with flexibilities provided during the covid-19 emergency and beyond. Our findings will enable policymakers to develop clinically and culturally nuanced policies and practices tailored to the disabled population, the racial/ethnic minority patients and rural patients, and the evolving pandemic/post-pandemic environment.
Transactions
| Action | Obligated | Date |
|---|---|---|
| Amendment | $0 | |
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| Amendment | $0 | |
| Amendment | $568,105 | |
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| Amendment | $568,105 | |
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| Amendment | $568,105 | |
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| Amendment | $568,105 | |
| Amendment | $637,123 | |
| Amendment | $627,760 | |
| Amendment | $627,760 | |
| Amendment | $701,067 | |
| Original award | $701,067 |
Show all 19
Subawards
| Subrecipient | Amount | Awarded |
|---|---|---|
| Harvard Pilgrim Health Care, Inc. | $214,700 | |
| Duke University | $43,668 | |
| The Washington University | $19,383 | |
| Harvard Pilgrim Health Care, Inc. | $282,295 | |
| University Of Wisconsin System | $14,140 | |
| Duke University | $221,904 | |
| University Of Wisconsin System | $87,707 | |
| The Washington University | $228,581 |
Quick answers
Who received award R01DA055131?
R01DA055131 was awarded to Emory University by National Institute on Drug Abuse (National Institutes of Health) on August 15, 2022.
How much is award R01DA055131 worth?
$5,567,197 has been obligated on R01DA055131.
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