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Reducing Doctor Shopping Via Insurance Reimbursement Lock-In Programs

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Some individuals engage in “doctor shopping” to obtain large quantities of prescription opioids to use or sell. One large U.S. study found that a small proportion (0.7%) of individuals prescribed opioids were apparently doctor shoppers, averaging 10 prescribers and 32 prescriptions. This practice poses grave risks to participants, including legal penalties, addiction, and overdose. 



Reimbursement lock-in programs are a simple and cost-effective method of intervening with individuals who obtain very large quantities of opioids from multiple prescribers or pharmacies.

Collaboration across insurers may increase the effectiveness of lock-in programs so that individuals can’t evade them by switching payors. This way, high-risk individuals (e.g., those who have overdosed) are more easily detected.

Key Policy Evidence: