The lock-in loophole: Using mixed methods to explain patient circumvention of a Medicaid opioid restriction program.

ABSTRACT:

Background

Lock-in programs are proliferating among private and public payers to restrict access to controlled substance prescriptions and enhance care coordination for patients exhibiting high-risk use of, primarily, opioids. Patients enrolled in lock-in programs are required to seek opioids from a designated provider and pharmacy for insurance coverage of their opioid and benzodiazepine prescriptions. Lock-in program restrictions are often circumvented by patients through out-of-pocket cash purchases of opioid prescriptions, undermining the program's intended function. This study sought to construct and explain trajectories of Medicaid-covered and cash pay opioid prescription fills among adults enrolled in an opioid lock-in program. Methods: We used sequential explanatory

SUBMITTER: Roberts AW 

PROVIDER: S-EPMC7176522 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature