Abstract
Background
Models of health care coverage with varying degrees of patient cost-sharing have been
shown to influence health care behaviors for chronic conditions including medication
adherence. The effect of insurance cost-sharing subsidies on the probability of postoperative
opioid refill, however, is unclear.
Methods
This retrospective cohort study examined 100% Medicare claims data among patients
(N = 21,781) ages 65 and older undergoing orthopedic procedures in Michigan between
January 2013 and September 2016. Patients were classified based on the presence of
low-income subsidy and on prior opioid exposure using Medicare Part D prescription
files of drug events. We investigated the association of these factors with the probability
of both initial and second postoperative opioid fill within 90 days from the date
of discharge.
Results
In this cohort, 84.6% of patients filled an initial opioid prescription, and 66.4%
refilled an opioid prescription. Patients with a full low-income subsidy had greater
odds of refill within the postoperative 90 days compared with those patients without
a low-income subsidy (odds ratio 1.38, 95% confidence interval 1.18–1.60). Among opioid
naïve patients with a full low-income subsidy, the adjusted refill rate was 61.3%
(95% confidence interval 58.0–64.7%) compared with 57.6% (95% confidence interval
51.4–63.7%) among those with partial low-income subsidy and 54.2% (95% confidence
interval 52.8–55.6%) among patients without low-income subsidy.
Conclusion
Among Medicare patients undergoing orthopedic procedures, a full medication subsidy
is associated with an increased probability of opioid refill when compared with no
subsidy. Going forward, it is critical to lessen financial barriers to ensure all
patients have equitable access to postoperative analgesia, including both opioid and
nonopioid analgesics by decreasing the patient burden of cost-sharing.
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Article info
Publication history
Published online: June 04, 2020
Accepted:
April 4,
2020
Identification
Copyright
© 2020 Published by Elsevier Inc.
