Pain | Impact of HEDIS and Medicare Star Quality Measures on Prescribing of Pain Drugs | Access and Reimbursement | US | 2016

In an era when healthcare payers are demanding more value for the money they spend on health services and pharmaceuticals, managed care organizations increasingly have focused on meeting nationally accepted quality measures that are used to judge their performance and, in turn, that MCOs use to hold providers accountable for their healthcare and prescribing decisions. The national attention to the misuse and abuse of opioid analgesics makes the chronic pain market ripe for examination in the context of quality improvement programs, such as the Medicare star rating program (which rewards high-performing Medicare Advantage plans with increased reimbursement) and the Healthcare Effectiveness Data and Information Set (HEDIS). This access & reimbursement content examines the effect of quality measures—as well as recent opioid advisories by the Centers for Disease Control and Federal Drug Administration—on MCO reimbursement policies for opioids and brand prescribing by primary care physicians and pain specialists. Although the focus is on opioid analgesics, other chronic pain drugs are also included in the examination.

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