Table 1.
Frequency of policy characteristics
| States, Number (%) N=22 | Policies, Number (%) N=31 | |
|---|---|---|
| Type of Policy | ||
| Guideline | 13 (59%) | 15 (48%) |
| Rule/Regulation | 4 (18%) | 4 (13%) |
| Prior Authorization | 4 (18%) | 4 (13%) |
| Legislative Act | 3 (14%) | 4 (13%) |
| Claim Denial | 2 (9%) | 2 (6%) |
| Alert System/Automatic Patient Report | 2 (9%) | 2 (6%) |
| Sponsoring Organization | ||
| Medical Board | 9 (41%) | 9 (29%) |
| Medicaid | 6 (27%) | 7 (23%) |
| Workers’ Compensation | 5 (23%) | 6 (19%) |
| Health Department | 5 (23%) | 5 (16%) |
| State Legislature | 3 (14%) | 4 (13%) |
| Pharmacy Board | 2 (9%) | 2 (6%) |
| Prescription Drug Monitoring Program | 2 (9%) | 2 (6%) |
| Threshold Level | ||
| 30 | 2 (9%) | 2 (6%) |
| 50 | 1 (5%) | 1 (3%) |
| 60 | 1 (5%) | 1 (3%) |
| 80 | 3 (14%) | 4 (13%) |
| 90 | 4 (18%) | 4 (13%) |
| 100 | 5 (23%) | 5 (16%) |
| 120 | 10 (45%) | 11 (35%) |
| 300 | 2 (9%) | 2 (6%) |
| Patient exclusions | ||
| Terminal/hospice/palliative care patients | 12 (55%) | 14 (45%) |
| Acute/etiologic pain | 10 (45%) | 10 (32%) |
| Cancer/malignant pain | 8 (36%) | 11 (35%) |
| Long-term care facility/nursing home patients | 5 (23%) | 5 (16%) |
| Emergency Room care patients | 2 (9%) | 2 (6%) |
| Other patient groups | 3 (14%) | 3 (10%) |
| No patient groups excluded | 7 (32%) | 7 (23%) |
| Short courses of opioids excluded | 5 (23%) | 5 (16%) |
| Excluded circumstances | ||
| Specialist consulted | 14 (64%) | 15 (48%) |
| Pain contract/patient education | 7 (32%) | 7 (23%) |
| Evidence of tapering | 4 (18%) | 4 (13%) |
| Clinical judgment | 6 (27%) | 7 (23%) |
| Improved pain or function | 5 (23%) | 5 (16%) |
| Prescription Drug Monitoring Program checked | 4 (18%) | 4 (18%) |
| Drug testing | 3 (14%) | 3 (10%) |
| Other circumstances specified | 3 (14%) | 3 (10%) |
| No circumstances specified | 9 (41%) | 10 (32%) |