Chronic Pain Management in Managed Care Organizations: A National Survey of Medical Directors

A national mailed survey of medical directors was conducted to determine the extent to which managed care organizations (MCOs) are managing chronic pain. The overall survey response rate was 25.5%. Of the responding MCOs, 32% had a formalized mechanism for identifying members with chronic pain and 18% systematically used clinical practice guide- lines for pain management. Many more MCOs had formulary controls in place to manage pain medications. Among the most commonly used controls cited were (1) controlling number of units per month (57%), (2) having tiered co-pays (56%), and (3) requiring prior authorization for specific agents (54%). The most important considerations cited in mak- ing formulary determinations included (1) efficacy, when com- pared with other leading analgesics (88%), (2) the side-effect profile and tolerability (82%), (3) improvement in the patient's functional ability (76%), (4) warnings and contraindications (75%), and (5) cost (74%). Of the MCOs that did not have a pain- management program, most (78%) considered pain in patients to be a low priority; however, 59% of all respondents expressed concern about the impact of pain medications on the pharmacy budget. The findings suggest that additional effort must go into under- standing the impact of pain on medical utilization, productivity, and quality of life, in addition to developing programs that increase MCOs' attention to pain management as a care- delivery priority.