Sending letters to potential overprescribers did not influence Schedule II prescribing activities.

Man with prescriber letters

Man with prescriber letters

What was the challenge?

Inappropriate prescribing can threaten patient health and increase healthcare costs. A body of research shows evidence of some providers overprescribing certain pharmaceuticals, including Schedule II drugs (e.g., opioids). Through its Center for Program Integrity (CPI), the Centers for Medicare and Medicaid Services (CMS) uses a variety of approaches to combat overprescribing.

What was the program change?

Studies have shown that letters, especially those highlighting social comparisons, can motivate individuals to more carefully examine their own behavior. We developed letters designed to educate providers and induce them to “self-audit” to correct potentially improper prescriptions.

How did the evaluation work?

CMS identified potential improper prescribers (those who prescribed far more than their peers in the same state and medical specialty.) 1,518 providers were randomly assigned to be sent a letter, or not.

What was the impact?

Using data collected over the 90 days after the letter was mailed, comparisons failed to detect an effect of the letter on Schedule II prescribing.

Related publications
Adam Sacarny, David Yokum, Amy Finkelstein, and Shantanu Agrawal. Medicare letters to curb overprescribing of controlled substances had no detectable effect on providers. Health Affairs 35 no. 3 (2017): 471-479.
Adam Sacarny, David Yokum, and Shantanu Agrawal. Government-academic partnerships in randomized evaluations: the case of inappropriate prescribing, American Economic Review 107, no. 5, (2017): 466-470.





Project Type

Impact evaluation of program change


Health and Human Services



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