An interesting article titled “Opioid Formulary Edit’s Impact on Commercial Dental Prescribers” was presented on July 23, 2021, at the virtual session of the 2021 International Association for Dental Research (IADR)/AADR/CADR General Session written by David Hamlin and et al. The research set to investigate the impact the insurance company Cigna had when it implemented its three-day quantity limit on dental opioid prescriptions. Insurance companies limiting new opioid prescriptions for dentists to three days (or another time duration) has been discussed on this site before in the post Insurance Companies Limiting Access to Opioids After Wisdom Teeth Surgery. The authors speculated that by limiting opioid prescriptions to three day there would be year-over-year reductions in prescriptions greater than three days and reductions in the average total metric quantity per prescription.
In the study, the authors looked at the claims of dentists in the Cigna network in the first half of 2020 and compared to the first half in 2019. Dentists were compared to a parallel cohort of orthopedic surgeons to control for background trend. The authors looked at two outcomes: 1) the proportion of opioid prescriptions greater than a three days supply and 2) the average total metric quantity/prescription.
The authors looked at 388 dental prescribers (63% male spanning 22,899 patient encounters) and 579 orthopedic surgeon prescribers (89% male, spanning 15,789 patient encounters). Among dentists they found that the proportion of opioid prescriptions greater than a three day supply was 0.21 prior to implementing the 3 day limit and 0.15 afer implementing the three day limit. They found a flat trend for orthopedic surgeons (0.80 vs. 0.81). The authors also found that the average total metric quantity/prescription among dentists decreased from 16.5 prior to implementing the 3 day limit to 15.2 afer implementing the three day limit. They found that for orthopedic surgeons the average total metric quantity/prescription among them decreased from 40.0 prior to implementing the 3 day limit to 37.6 afer implementing the three day limit. The authors also shared that over the entire Cigna plan the average total metric quantity/prescription delta for dentists between 2020 and 2019, was -555,187 units (-25%) while for orthopedic surgeons between 2020 and 2019 it was – 1,037,537 units (-15%).
The authors feel that Cigna’s three day limit for dental opioid prescriptions led to a marked reduction in the proportion of opioid prescriptions greater than a three days supply but the impact on the average total metric quantity/prescription was not as prounced. The authors feel that strategies to reduce opioid prescribing among dentists could be helped by focusing on the average total metric quantity/prescription and not just the three day supply quantity limit.
It is noteworthy that the authors of this study all work for the insurance company Cigna. It also appears dental insurance companies like Cigna are now trying to play play the role of regulator in the battle against opioid addiction. It is not clear from the study if the patients who received the three day opioid prescriptions are experiencing sufficient pain relieve from the procedures they had.
2 thoughts on “Assessing the Impact of Three Day Opioids Limits for Dentists”