CMS Campaign Targets Physicians Who Overprescribe Addictive Drugs

The results of a randomized trial of informative letters aimed at top suspected inappropriate prescribers of addictive substances showed no statistically significant effect, but researchers claim the information will be useful for policymakers in the future.

During the trial, researchers from Columbia University’s Mailman School of Public Health sent out letters to physicians and practitioners believed to over-prescribe addictive substances like opioids and amphetamines, which informs them of their high prescribing rate.

“Because we used a randomized controlled trial approach with this intervention, we were able to produce gold standard evidence on its effectiveness,” said researcher Adam Sacarny, PhD. “Even though we weren't able to show that the letters were effective, this information is still useful for policymakers. This is why it's so important to rigorously test these interventions. Based on these results, we're now experimenting with different letter designs and making other changes to see if another approach can yield reductions in overprescribing.”

A study published in Health Affairs had a primary focus on Schedule 2 controlled substances through the Medicare Part D prescription drug insurance program. These medications include the opioids OxyContin and Percocet or stimulates like amphetamines.

A data repository at the Centers for Medicare and Medicaid Services (CMS) was used to help identify physicians and other practitioners who prescribed on average more than 400% of controlled substances compared with their peers.

CMS created a letter for prescribers that incorporated insights from behavioral science research. The researchers then evaluated the letter using a randomized and controlled trial approach similar to most clinical trials.

There were 1525 prescribers enrolled in the study, with half randomly selected to receive a letter. Next, researchers used the CMS data repository to track the effect the letter had on prescribing behavior during the following 90 day period.

This intervention is CMS’ first systematic letter campaign that looks to reduce inappropriate practices. However, it is an extension of a program already in existence that gives informative letters with peer comparisons on physician billing behavior.

“We could not find any evaluations of the other program, and believe our work fills in that gap,” Sacarny said. “We also think that our evidence could be useful for other insurers, including other parts of Medicare, when they look to improve their communications with providers.

“We view these findings as part of a process of continuous improvement. We've shown that we can run these evaluations quickly and rigorously. While we didn't detect an effect of our efforts in this trial, we're now regrouping for the next round.”

Researchers will continue their work on a new study that targets high prescribers of an antipsychotic called Seroquel.

“This intervention uses better data and a redesigned letter to build as much as possible on the first round,” Sacarny said.