North Carolina Medicaid recipient management lock-in program

the pharmacist's perspective

S. Rose Werth, Nidhi Sachdeva, Andrew W. Roberts, Mariana Garrettson, Chris Ringwalt, Leslie A. Moss, Theodore Pikoulas, Asheley C ockrell Skinner

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits. 

OBJECTIVES: To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success. 

METHODS: We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability. 

RESULTS: Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists. 

CONCLUSIONS: Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.

Original languageEnglish (US)
Pages (from-to)1122-1129
Number of pages8
JournalJournal of managed care & specialty pharmacy
Volume20
Issue number11
StatePublished - Nov 1 2014
Externally publishedYes

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Medicaid
Pharmacists
Medical Assistance
Opiate Alkaloids
Controlled Substances
Health
Patient treatment
Prescription Drugs
Anti-Anxiety Agents
Benzodiazepines
Health care
Opioid Analgesics
Prescriptions
Prescription Drug Misuse
Interviews
Communication
Health Services Accessibility
Organizations
Morbidity
Physicians

All Science Journal Classification (ASJC) codes

  • Pharmacy
  • Pharmaceutical Science
  • Health Policy

Cite this

Werth, S. R., Sachdeva, N., Roberts, A. W., Garrettson, M., Ringwalt, C., Moss, L. A., ... Skinner, A. C. O. (2014). North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective. Journal of managed care & specialty pharmacy, 20(11), 1122-1129.

North Carolina Medicaid recipient management lock-in program : the pharmacist's perspective. / Werth, S. Rose; Sachdeva, Nidhi; Roberts, Andrew W.; Garrettson, Mariana; Ringwalt, Chris; Moss, Leslie A.; Pikoulas, Theodore; Skinner, Asheley C ockrell.

In: Journal of managed care & specialty pharmacy, Vol. 20, No. 11, 01.11.2014, p. 1122-1129.

Research output: Contribution to journalArticle

Werth, SR, Sachdeva, N, Roberts, AW, Garrettson, M, Ringwalt, C, Moss, LA, Pikoulas, T & Skinner, ACO 2014, 'North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective', Journal of managed care & specialty pharmacy, vol. 20, no. 11, pp. 1122-1129.
Werth SR, Sachdeva N, Roberts AW, Garrettson M, Ringwalt C, Moss LA et al. North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective. Journal of managed care & specialty pharmacy. 2014 Nov 1;20(11):1122-1129.
Werth, S. Rose ; Sachdeva, Nidhi ; Roberts, Andrew W. ; Garrettson, Mariana ; Ringwalt, Chris ; Moss, Leslie A. ; Pikoulas, Theodore ; Skinner, Asheley C ockrell. / North Carolina Medicaid recipient management lock-in program : the pharmacist's perspective. In: Journal of managed care & specialty pharmacy. 2014 ; Vol. 20, No. 11. pp. 1122-1129.
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abstract = "BACKGROUND: The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits. OBJECTIVES: To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success. METHODS: We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability. RESULTS: Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists. CONCLUSIONS: Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.",
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AU - Moss, Leslie A.

AU - Pikoulas, Theodore

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N2 - BACKGROUND: The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits. OBJECTIVES: To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success. METHODS: We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability. RESULTS: Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists. CONCLUSIONS: Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.

AB - BACKGROUND: The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits. OBJECTIVES: To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success. METHODS: We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability. RESULTS: Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists. CONCLUSIONS: Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.

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