Table 3.

Insurer and pharmacy benefit manager strategies.

Type outcomes	Study design	Number of studies	Findings
Provider behavior *Low	Descriptive/before-after	4	Decrease in mean number of CII-CV prescription drug claims PMPM (Hoffman et al., 2003)SS Decrease in mean number of prescribers per patient (Hoffman et al., 2003)SS No change in mean numberoftotal prescriptions PMPM (Hoffman et al., 2003)NS Decrease in long-acting opioid prescriptions and opioid duplication (Oregon State University, 2012)NT Decrease in percent of patients taking >100 morphine milligram equivalents of methadone (Oregon State University, 2012)NT Decrease in sedative/hypnotic prescriptions and quantities per prescription (Oregon State University, 2004b)NT Decrease in carisoprodol prescriptions, quantities per prescription, and average daily dose (Oregon State University, 2004a)NT
	Time series	3	Decrease in rates of poly-pharmacy events for opioids and benzodiazepines (Zarowitz et al., 2005)SS Decrease in mean controlled substance score driven by reduced number of controlled substance prescriptions and reduced numbers of prescribers and pharmacies utilized (Daubresse et al., 2014)SS Decrease in controlled-release oxycodone use in states with strict prior authorization criteria (Morden et al., 2008)SS No change in controlled-release oxycodone use in states with lenient prior authorization criteria (Morden et al., 2008)SS
	RCT	1	Greater reduction in number of prescribers, dispensing pharmacies, and filled opioid prescriptions compared to control group (Gonzalez and Kolbasovsky, 2012)SS
Patient behavior *Low	Descriptive/before-after	2	Decrease in provider visits, number of opioid prescriptions, and mean daily morphine milligram equivalent dose (CDC, 2013)SS Decrease in opioid and sedative use (Tanenbaum and Dyer, 1990)SS
	Time series	3	Decrease in rates of poly-pharmacy events for opioids and benzodiazepines (Zarowitz et al., 2005)SS Decrease in numberof prescriberand pharmacies (Blake, 1999; Mitchell, 2009)SS Decrease in poly-pharmacy and CII opioid prescriptions (Blake, 1999)SS Decrease in number of opioid prescriptions (Mitchell, 2009)SS
	RCT	0
Health outcomes *Low	Descriptive/before-after	2	No change in rate ofED services, hospitalizations, or office visits among carisoprodol patients (Oregon State University, 2004a)NT Decrease in ED visits for injuries from any cause (CDC, 2013)SS No change in mortality (CDC, 2013)NS
	Time series RCT	1 0	Decrease in ED visits (Mitchell, 2009)SS

Note:

^SS= Tested and statistically significant

^NS= Tested and not statistically significant

^NT= No statistical testing conducted

^*= Evidence level.