Association of Out-of-Pocket Costs, Prescription Opioid Use

Increasing out-of-pocket costs has minimal effect on prescription opioid use, according to a poster presented at the American Academy of Pain Medicine’s 36th Annual Meeting.

Rebecca, Harris, MD, conducted a retrospective cohort study “examining the effects of deductibles and copays on the number of opioid prescriptions dispensed to privately insured individuals in outpatient clinics.”

“The Trump administration (and others) have proposed increases in out-of-pocket costs for opioid prescriptions to curb excessive use,” explained Dr Harris.  “However, there is currently no evidence on how opioid consumption responds to cost sharing outside of the Medicare Part D context, where the findings have been inconsistent.”

The study followed 4300 patients who presented with acute back pain and had received at least one prescription for opioids. None of the patients had presented with acute back pain or filled an opioid prescription for the year prior to the beginning of the study. 

For 270 days in 2016, negative binomial regression was utilized to measure the potential impact of out-of-pocket costs on the number of opioid fills, controlling for physician propensity to prescribe opioids, patient socio-economic characteristics, comorbidities and previous heath care utilization (to correct for adverse selection), morphine milligram equivalents, aBP subtypes, and other potential confounders.

The effect of cost on the number of fills was minimal (for deductibles: elasticity=-.02, P=0.004; for copays: elasticity=-.04, P=.025); ie, a 100% increase in out-of-pocket costs corresponded to a 2-4% reduction in fills. 

Because of these results, Dr Harris concluded that “it is unlikely that raising out-of-pocket costs will meaningfully reduce prescription opioid use among commercially insured patients.”  —Edan Stanley