title: North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.
abstract: BACKGROUND
  The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits.
  
  
  OBJECTIVE
  To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.
  
  
  METHODS
  We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability.
  
  
  RESULTS
  Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists.
  
  
  CONCLUSIONS
  Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, 231 MacNider, 229B, CB 7225, Chapel Hill, NC 27599. asheley@unc.edu.
authors.forename: S Rose
authors.initials: SR
authors.lastname: Werth
authors.forename: Nidhi
authors.initials: N
authors.lastname: Sachdeva
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Roberts
authors.forename: Mariana
authors.initials: M
authors.lastname: Garrettson
authors.forename: Chris
authors.initials: C
authors.lastname: Ringwalt
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Moss
authors.forename: Theodore
authors.initials: T
authors.lastname: Pikoulas
authors.forename: Asheley Cockrell
authors.initials: AC
authors.lastname: Skinner
mesh_terms: D014151:Anti-Anxiety Agents; D001291:Attitude of Health Personnel; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence*; D007407:Interviews as Topic; D008484:Medicaid / Q000331:legislation & jurisprudence*; D009657:North Carolina; D009293:Opioid-Related Disorders / Q000517:prevention & control; D010595:Pharmacists / Q000523:psychology*; D019966:Substance-Related Disorders / Q000517:prevention & control*; D014481:United States
chemical_list: D014151:Anti-Anxiety Agents