Pharmacists and pharmacy-benefit managers were among the audiences addressed by the opioid study published in MMWR on March 17, 2017. The University of Arkansas researchers associated early prescribing patterns with later continuation in selected US adults. That makes a refill a potential decision point for scrutiny. It does not show that denying a refill saves money or improves a patient's health. [mm6610a1]

The authors estimated one-year continuation at 13.5 percent for initial episodes of at least eight days and 29.9 percent for episodes of at least 31 days. These episodes could combine multiple prescriptions with gaps up to 30 days; they were not simply single-prescription lengths. The records lacked pain intensity and duration, so the comparison cannot isolate the effect of imposing a shorter allowance. [mm6610a1]

The earlier CDC guideline supplies a constraint on policy interpretation. Its 2016 recommendations were voluntary and emphasized the patient's clinical circumstances. Its principal scope was adult outpatient primary-care chronic pain, excluding active cancer treatment, palliative care and end-of-life care. That is a clinical framework, not a benefit-design study showing which authorization system offers the best trade-off between access, cost and harm. [rr6501e1]

Our incentives question is what information a refill process rewards people for obtaining. A count alone is cheaper to describe than the reason pain persists, but these sources do not compare administrative costs or demonstrate that either approach works better. The study and guideline support examining the decision, not claiming proven savings, reduced addiction or an optimal restriction. This retrospective is not current advice about prescriptions or insurance coverage. [mm6610a1][rr6501e1]

Source documents

  1. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm
  2. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm