March 24, 2014

OHCA Contacts: Jo Kilgore - (405) 522-7474, Jennie Melendez - (405) 522-7404

The mission of the OHCA Lock-In Program is to assist health care providers in monitoring potential abuse or inappropriate utilization of controlled prescription medications by SoonerCare members. 

The Oklahoma Health Care Authority (OHCA) has a new weapon in the war against prescription drug abuse. The agency has ramped-up its Pharmacy Lock-in Program so that certain SoonerCare (Oklahoma Medicaid) members cannot receive controlled substances from more than one health care provider. The measure aims to deter the practice of doctor shopping and prevent the possibility of accidental drug overdose – a growing and deadly problem in Oklahoma. The new lock-in requirement begins in summer 2014.

“We simply feel this is a necessary change to create a more effective and relevant lock-in program,” said OHCA’s Health Care Management Medical Director, Dr. Mike Herndon. “We believe this additional measure will have a significant impact on the number of prescriptions those members who are in the Lock-in Program are able to acquire.”

Presently, those SoonerCare members who are at risk of misusing prescribed controlled substances are restricted to the use of one pharmacy to fill all of their medications. The new requirement will limit these members to using both a single pharmacy and prescriber (health care provider). Pharmacy claims will be blocked from a prescriber who is not the lock-in member’s authorized prescriber. However, this lock-in will only apply to controlled substance prescriptions, including the painkillers Hydrocodone and Oxycodone.

Prescription drug abuse is an epidemic in Oklahoma, particularly in regard to narcotics. According to a recent report by the Trust for America’s Health, the Sooner state has the fifth highest drug overdose mortality rate in the U.S., a rate that tripled from 1999 to 2010. Other facts include:

• Oklahoma ranks eighth nationally for prescription drug addiction ₁;
• Oklahoma pharmacies filled nearly 10 million prescriptions for narcotic painkillers and other controlled substances in 20132;
• Non-medical use of prescription painkillers occurs in about 5 percent of the population ₃;
• Most Oklahomans who abuse prescription painkillers get them from their doctor or an acquaintance _3,4; and
• Most of Oklahoma’s drug-related deaths involve multiple substances.₃ 

The primary goal of the new OHCA lock-in provision is for SoonerCare members to receive the prescribed medication they need (including prescription painkillers) in the safest manner possible.

“This measure should not impact those members who seek to legitimately control their chronic pain since only those members who have been identified as being at risk for abuse, misuse or diversion are in the lock-in program,” said Herndon. “This change actually put us more in line with other state Medicaid agencies’ lock-in policies.”

1. Trust for America’s Health. Drug Abuse 2013 Data for Oklahoma. Available at: http://healthyamericans.org/reports/drugabuse2013/release.php?stateid=OK. Accessed March 13, 2014.
2. Vieth, Warren. As Drug Deaths Rise, Millions of Narcotic Prescriptions Filled. Oklahoma Watch. February 7, 2014. http://oklahomawatch.org/2014/02/07/as-drug-deaths-rise-millions-of-narcotic-prescriptions-filled/. Accessed March 14, 2014.
3. Putnam, Carly. Prescription Drug Abuse in Oklahoma Fact Sheet. Oklahoma Policy Institute. March 2014. http://okpolicy.org/wp-content/uploads/prescription-drug-abuse.pdf. Accessed March 17, 2014.
4. Oklahoma Health Department. Prescription Drug Abuse Fast Growing Problem in Oklahoma. https://www.ok.gov/health/Organization/Office_of_Communications/News_Releases/2013_News_Releases/Prescription_Drug_Abuse_Fast_Growing_Problem_in_Oklahoma.html. March 13, 2013. Accessed March 18, 2014.

_{Oklahoma’s Medicaid program, known as SoonerCare, is administered by the Oklahoma Health Care Authority (OHCA). SoonerCare works to improve the health outcomes of Oklahomans by ensuring that medically necessary benefits and services are responsive to the health care needs of our members. Qualifying Oklahomans include certain low-income children, seniors, the disabled, those being treated for breast or cervical cancer and those seeking family planning services. Insure Oklahoma assists qualifying adults and small business employees in obtaining health care coverage for themselves and their families. OHCA strives to educate and engage our current 818,063 members regarding personal responsibilities for their health services utilization, behaviors, and outcomes in partnership with a state-wide network of 38,305 providers. For more information, visit www.okhca.org.} 

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