Strategies aimed at controlling misuse and abuse of opioid prescription medications in a state Medicaid program: a policymaker’s perspective

Figures & data

Figure 1. Opioid prescription claims per utilizer per month. Each letter corresponds to a policy listed in Table 1.

Table 1. List of Oklahoma SoonerCare policy implementations and dates.

Identifier*	Date	Policy category	Products or action
A	October 2003	Quantity limits	Fentanyl, hydromorphone, methadone, merperidine, and oxycodone (additional quantity limits added over time)
B	January 2006	Pharmacy Lock-In program	Intensification of previous ‘Lock-In’ management
C	April 2006	Prior authorization	Applied to tramadol products
D	November 2007	ProDUR	Restriction of hydrocodone to 1 claim per day supply
E	July 2008	Step therapy program	Step therapy (3 tiers and oncology-only tier)
F	August 2009	ProDUR	Hydrocodone ingredient duplication
G	October 2009	Quantity limit	Applied to all narcotic/acetaminophen combination products
H	August 2010	Prescription limit	Hydrocodone limited to 13 prescriptions per 360 day period
I	May 2011	Prior authorization	Applied to buprenorphine
J	July 2011	Prescriber restrictions	Removal of non-contracted prescribers
K	March 2013	Prior authorization	Branded oxymorphone extended-release preferred over new generic product
L	March 2013	Age restrictions	Applied to liquid and solid opioid dosage forms

*Each letter corresponds to the date of initial implementation on Figure 1.