Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design.
Adolescent
Adult
Aged
Analgesics, Opioid
/ economics
Buprenorphine
/ economics
Cohort Studies
Cost Sharing
/ statistics & numerical data
Female
Health Expenditures
/ statistics & numerical data
Humans
Insurance, Health
/ statistics & numerical data
Male
Medication Adherence
/ statistics & numerical data
Methadone
/ economics
Middle Aged
Naltrexone
/ economics
Opiate Substitution Treatment
/ economics
Opioid-Related Disorders
/ drug therapy
United States
Young Adult
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
pubmed:
14
1
2022
medline:
4
3
2022
entrez:
13
1
2022
Statut:
ppublish
Résumé
The association between cost-sharing and receipt of medication for opioid use disorder (MOUD) is unknown. We constructed a cohort of 10,513 commercially insured individuals with a new diagnosis of opioid use disorder and information on insurance cost-sharing in a large national deidentified claims database. We examined 4 cost-sharing measures: (1) pharmacy deductible; (2) medical service deductible; (3) pharmacy medication copay; and (4) medical office copay. We measured MOUD (naltrexone, buprenorphine, or methadone) initiation (within 14 d of diagnosis), engagement (second receipt within 34 d of first), and 6-month retention (continuous receipt without 14-d gap). We used multivariable logistic regression to assess the association between cost-sharing and MOUD initiation, engagement, and retention. We calculated total out-of-pocket costs in the 30 days following MOUD initiation for each type of MOUD. Of 10,513 individuals with incident opioid use disorder, 1202 (11%) initiated MOUD, 742 (7%) engaged, and 253 (2%) were retained in MOUD at 6 months. A high ($1000+) medical deductible was associated with a lower odds of initiation compared with no deductible (odds ratio: 0.85, 95% confidence interval: 0.74-0.98). We found no significant associations between other cost-sharing measures for initiation, engagement, or retention. Median initial 30-day out-of-pocket costs ranged from $100 for methadone to $710 for extended-release naltrexone. Among insurance plan cost-sharing measures, only medical services deductible showed an association with decreased MOUD initiation. Policy and benefit design should consider ways to reduce cost barriers to initiation and retention in MOUD.
Sections du résumé
BACKGROUND
The association between cost-sharing and receipt of medication for opioid use disorder (MOUD) is unknown.
METHODS
We constructed a cohort of 10,513 commercially insured individuals with a new diagnosis of opioid use disorder and information on insurance cost-sharing in a large national deidentified claims database. We examined 4 cost-sharing measures: (1) pharmacy deductible; (2) medical service deductible; (3) pharmacy medication copay; and (4) medical office copay. We measured MOUD (naltrexone, buprenorphine, or methadone) initiation (within 14 d of diagnosis), engagement (second receipt within 34 d of first), and 6-month retention (continuous receipt without 14-d gap). We used multivariable logistic regression to assess the association between cost-sharing and MOUD initiation, engagement, and retention. We calculated total out-of-pocket costs in the 30 days following MOUD initiation for each type of MOUD.
RESULTS
Of 10,513 individuals with incident opioid use disorder, 1202 (11%) initiated MOUD, 742 (7%) engaged, and 253 (2%) were retained in MOUD at 6 months. A high ($1000+) medical deductible was associated with a lower odds of initiation compared with no deductible (odds ratio: 0.85, 95% confidence interval: 0.74-0.98). We found no significant associations between other cost-sharing measures for initiation, engagement, or retention. Median initial 30-day out-of-pocket costs ranged from $100 for methadone to $710 for extended-release naltrexone.
CONCLUSIONS
Among insurance plan cost-sharing measures, only medical services deductible showed an association with decreased MOUD initiation. Policy and benefit design should consider ways to reduce cost barriers to initiation and retention in MOUD.
Identifiants
pubmed: 35026792
doi: 10.1097/MLR.0000000000001689
pii: 00005650-202203000-00010
pmc: PMC8852217
mid: NIHMS1764698
doi:
Substances chimiques
Analgesics, Opioid
0
Buprenorphine
40D3SCR4GZ
Naltrexone
5S6W795CQM
Methadone
UC6VBE7V1Z
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
256-263Subventions
Organisme : NIAID NIH HHS
ID : P30 AI042853
Pays : United States
Organisme : NIDA NIH HHS
ID : P30 DA040500
Pays : United States
Organisme : NCIPC CDC HHS
ID : R01 CE002999
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA046527
Pays : United States
Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Barocas JA, White LF, Wang J, et al. Estimated prevalence of opioid use disorder in Massachusetts, 2011-2015: a capture-recapture analysis. Am J Public Health. 2018;108:1675–1681.
Mattson CL, Tanz LJ, Quinn K, et al. Trends and geographic patterns in drug and synthetic opioid overdose deaths—United States, 2013-2019. MMWR Morb Mortal Wkly Rep. 2021;70:202–207.
Volkow ND, Wargo EM. Overdose prevention through medical treatment of opioid use disorders. Ann Intern Med. 2018;169:190–192.
Larochelle MR, Bernson D, Land T, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169:137–145.
Morgan JR, Schackman BR, Leff JA, et al. Injectable naltrexone, oral naltrexone, and buprenorphine utilization and discontinuation among individuals treated for opioid use disorder in a United States commercially insured population. J Subst Abuse Treat. 2018;85:90–96.
Meinhofer A, Witman AE. The role of health insurance on treatment for opioid use disorders: evidence from the Affordable Care Act Medicaid expansion. J Health Econ. 2018;60:177–197.
Wakeman SE, Larochelle MR, Ameli O, et al. Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Netw Open. 2020;3:e1920622.
Delbanco S, Murray R, Berenson R, et al. Payment Methods and Benefit Designs: How They Work and How They Work Togeher to improve Healthcare. Washington, DC: Urban Institute; 2016.
Saunders EC, Moore SK, Walsh O, et al. Perceptions and preferences for long-acting injectable and implantable medications in comparison to short-acting medications for opioid use disorders. J Subst Abuse Treat. 2020;111:54–66.
Murphy SM, McCollister KE, Leff JA, et al. Cost-effectiveness of buprenorphine-naloxone versus extended-release naltrexone to prevent opioid relapse. Ann Intern Med. 2019;170:90–98.
Kay ES, Pinto RM. Is insurance a barrier to HIV preexposure prophylaxis? Clarifying the issue. Am J Public Health. 2020;110:61–64.
Ciemins EL. The effect of parity-induced copayment reductions on adolescent utilization of substance use services. J Stud Alcohol. 2004;65:731–735.
OptumLabs. OptumLabs and OptumLabs Data Warehouse (OLDW) Descriptions and Citation. Eden Prairie, MN. Reproduced with permission from OptumLabs. 2020.
Larochelle MR, Liebschutz JM, Zhang F, et al. Opioid prescribing after nonfatal overdose and association with repeated overdose: a cohort study. Ann Intern Med. 2016;164:1–9.
Galbraith AA, Ross-Degnan D, Soumerai SB, et al. Nearly half of families in high-deductible health plans whose members have chronic conditions face substantial financial burden. Health Aff (Millwood). 2011;30:322–331.
AARP Medicare Advantage. United Healthcare. 2020 complete drug list (formulary). Formulary ID Number 00020047, Version 9 Y0066_190628_124536_C v15.01. 2019. Available at: www.aarpmedicareplans.com/alphadms/ovdms10g/groups/ov/@ov/@highrespdf/documents/highrespdf/4624550.pdf . Accessed December 2, 2020.
Garnick DW, Lee MT, Chalk M, et al. Establishing the feasibility of performance measures for alcohol and other drugs. J Subst Abuse Treat. 2002;23:375–385.
US Food and Drug Administration (FDA). Medication guide: Vivitrol (naltrexone for extended-release injectable suspension). 2013. Available at: www.fda.gov/downloads/Drugs/DrugSafety/UCM206669.pdf . Accessed June 2, 2021.
US Food and Drug Administration (FDA). Sublocade package insert. 2017. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2017/209819s000lbl.pdf . Accessed June 2, 2021.
Busch SH, Fiellin DA, Chawarski MC, et al. Cost-effectiveness of emergency department-initiated treatment for opioid dependence. Addiction. 2017;112:2002–2010.
Shafi S, Collinsworth AW, Copeland LA, et al. Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients in a large integrated health care delivery system. JAMA Surg. 2018;153:757–763.
Roberts AW, Saloner B, Dusetzina SB. Buprenorphine use and spending for opioid use disorder treatment: trends from 2003 to 2015. Psychiatr Serv. 2018;69:832–835.
O’brien RM. A caution regarding rules of thumb for variance inflation factors. Qual Quant. 2007;41:673–690.
Olfson M, Zhang VS, Schoenbaum M, et al. Trends in buprenorphine treatment in the United States, 2009-2018. JAMA. 2020;323:276–277.
Haffajee RL, Lin LA, Bohnert ASB, et al. Characteristics of US counties with high opioid overdose mortality and low capacity to deliver medications for opioid use disorder. JAMA Netw Open. 2019;2:e196373.
Joudrey PJ, Chadi N, Roy P, et al. Pharmacy-based methadone dispensing and drive time to methadone treatment in five states within the United States: a cross-sectional study. Drug Alcohol Depend. 2020;211:107968.
Wakeman SE, Rich JD. Barriers to medications for addiction treatment: how stigma kills. Subst Use Misuse. 2018;53:330–333.
Jones ES, Moore BA, Sindelar JL, et al. Cost analysis of clinic and office-based treatment of opioid dependence: results with methadone and buprenorphine in clinically stable patients. Drug Alcohol Depend. 2009;99:132–140.
Larochelle MR, Wakeman SE, Ameli O, et al. Relative cost differences of initial treatment strategies for newly diagnosed opioid use disorder. Med Care. 2020;58:919–926.
Morgan JR, Barocas JA, Murphy SM, et al. Comparison of rates of overdose and hospitalization after initiation of medication for opioid use disorder in the inpatient vs outpatient setting. JAMA Netw Open. 2020;3:e2029676.
Snow RL, Simon RE, Jack HE, et al. Patient experiences with a transitional, low-threshold clinic for the treatment of substance use disorder: a qualitative study of a bridge clinic. J Subst Abuse Treat. 2019;107:1–7.
Morgan JR, Wang J, Barocas JA, et al. Opioid overdose and inpatient care for substance use disorder care in Massachusetts. J Subst Abuse Treat. 2020;112:42–48.
Morgan J, Schackman B, Weinstein Z, et al. Overdose following initiation of naltrexone and buprenorphine medication treatment for opioid use disorder in a United States commercially insured cohort. Drug Alcohol Depend. 2019;200:34–39.
Rosenblatt RA, Andrilla CH, Catlin M, et al. Geographic and specialty distribution of US physicians trained to treat opioid use disorder. Ann Fam Med. 2015;13:23–26.
Knudsen HK. The supply of physicians waivered to prescribe buprenorphine for opioid use disorders in the United States: a state-level analysis. J Stud Alcohol Drugs. 2015;76:644–654.
Hadland SE, Park TW, Bagley SM. Stigma associated with medication treatment for young adults with opioid use disorder: a case series. Addict Sci Clin Pract. 2018;13:15.
Bozinoff N, Anderson BJ, Bailey GL, et al. Correlates of stigma severity among persons seeking opioid detoxification. J Addict Med. 2017;12:19–23.
Olsen Y, Sharfstein JM. Confronting the stigma of opioid use disorder—and its treatment. JAMA. 2014;311:1393–1394.
Morgan JR, Walley AY, Murphy SM, et al. Characterizing initiation, use, and discontinuation of extended-release buprenorphine in a nationally representative United States commercially insured cohort. Drug Alcohol Depend. 2021;225:108764.
Blanco C, Volkow ND. Management of opioid use disorder in the USA: present status and future directions. Lancet. 2019;393:1760–1772.
Murphy SM, Morgan JR, Jeng PJ, et al. Will converting naloxone to over-the-counter status increase pharmacy sales? Health Serv Res. 2019;54:764–772.