Tramadol prescribing for US Family Health Plan members.

Monitor tramadol use to reduce risk and improve outcomes

Opioid prescription limits and policies vary by state, particularly with tramadol, as some states we service do not include tramadol in these limits. In an opioid-utilization analysis of our US Family Health Plan members, tramadol was identified as the top medication prescribed for extended-day supplies (15 days of prescription opioid within a 30-day period or 31 days of prescription opioid in a 62-day period). In most cases, these prescriptions were filled infrequently (for example, a patient who fills just one 30 or 90-day supply of tramadol per year).

NCQA implements a “Risk of Continued Opioid Use” measure, intended to identify patients at an increased risk for opioid overuse and misuse. The following factors are cited as to the importance of this measure:

• “Literature suggests that long-term opioid use often begins with the treatment of acute pain, and a relationship exists between early prescribing patterns and long-term use of opioids.”
• “Continued opioid use for noncancer pain is associated with increased risk of opioid use disorder, opioid-related overdose, hospitalization, and opioid overdose-related mortality.”
• “Studies find a consistent link between increasing days’ supply of the first prescription with probability of continued opioid use, and the rate of opioid use at 1 year post-initial prescription increases substantially for patients with 31 or more days of opioid therapy.”

We are committed to partnering with you to improve the quality of care and health outcomes for your patients. In an effort to decrease potential excess supply your patient has on hand, we respectfully encourage you to assess utilization before writing each prescription. Please check the prescription drug monitoring program and ask your patient how often they are taking their tramadol. Please update the prescription to a lower quantity and day supply or discuss discontinuing if possible. To assist in this effort, you may receive calls or faxes from us requesting you update the prescription based on our utilization review.

Resource: NCQA Risk of Continued Opioid Use Measure.