Disclosures: Allison Glinka Przybysz: No financial relationships or conflicts of interest  

Objective: Describe potential barriers to accessing first-line pharmacologic therapies used for treating pain in low-income patients with disabilities.

Design: Cross-sectional retrospective review.

Setting: NA

Participants: NA

Interventions: NA

Main Outcome Measures: Medicaid plan formulary data were analyzed for the state of Illinois. First-line pharmacologic pain therapies for common rehabilitation diagnoses including spinal cord injuries, post-stroke pain, phantom pain and neuropathies were analyzed. Prior authorization and quantity restrictions were used as a proxy for access. Using R statistical software, univariate and bivariate analyses were performed.

Results: Of the 41 prescription pain medications analyzed, 13 were prescription opioids. There were 28 non-opioids medications analyzed, including 8 non-steroidal anti-inflammatory drugs (NSAIDs), 8 anti-depressants, 6 muscle relaxants, 4 anticonvulsants, and 2 topical analgesics. When averaging across all Medicaid plans, 24.4% (IQR 17.7-26.8%) of pain medications require prior authorizations and 45.4% (IQR 33.3-54.1%) have quantity limitations. Among opioid medications, 34.6% (IQR 25.0-46.2%) require prior authorizations and 90.9% (IQR 90-100%) have quantity limitations. Among non-opioid medications, 19.9% (IQR 17.4-21.7%) require prior authorizations and 40.0% (IQR 26.7-42.7%) have quantity limitations. Using chi-squared analysis, we found a statistically significant difference between the proportion of quantity limitations (P=.003) and no statistically significant difference between the proportions of prior authorizations (P=.15) when comparing opioid and non-opioid medications.

Conclusions: There are increased quantity limitations on opioid pain medications compared to non-opioids, and a significant proportion of all pain medications covered by Medicaid require prior authorization. Limiting access to opioids likely represents an appropriate level of caution with regard to ensuring patient safety. Potential implications for Physical Medicine and Rehabilitation physicians is that increased time and advocacy may be required to ensure low-income patients with disabilities receive appropriate pain therapies.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/access-to-pain-medications-among-low-income-patients-with-disabilities/