Association Between Cost-Sharing and Buprenorphine Prescription Abandonment.

access buprenorphine cost-sharing health policy insurance. opioid use disorder

Journal

Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834

Informations de publication

Date de publication:
18 Jun 2024
Historique:
received: 29 12 2023
accepted: 13 05 2024
medline: 18 6 2024
pubmed: 18 6 2024
entrez: 18 6 2024
Statut: aheadofprint

Résumé

Prior studies suggest cost-sharing decreases buprenorphine dispensing. However, these studies used databases that only report prescriptions filled by patients, not those that were "abandoned." Consequently, the studies could not calculate the probability of buprenorphine prescription abandonment or evaluate whether cost-sharing is associated with abandonment. To evaluate the association between cost-sharing and buprenorphine prescription abandonment. Cross-sectional analysis of the IQVIA Formulary Impact Analyzer, a pharmacy transaction database representing 63% of U.S. retail pharmacies. The database includes transaction records ("claims") for prescriptions even if they are not filled. Buprenorphine claims in 2022 among commercially insured and Medicare patients. We evaluated the association between cost-sharing per 30-day supply and abandonment using logistic regression, controlling for patient characteristics, product type, and buprenorphine use in the prior 180 days. We assessed for effect modification by prior buprenorphine use. Analyses included 2,346,994 and 1,242,596 buprenorphine prescription claims for commercially insured and Medicare patients, respectively. Among these claims, mean (SD) cost-sharing per 30-day supply was $28.1 (46.4) and $8.4 (20.2), and 1.5% and 1.2% were abandoned. Each $10 increase in cost-sharing per 30-day supply was associated with a 0.09 (95% CI: 0.09, 0.10) and 0.09 (95% CI: 0.08, 0.10) percentage-point increase in abandonment among commercially insured and Medicare patients. Among commercially insured and Medicare patients without prior buprenorphine use, respectively, a $10 increase in cost-sharing per 30-day supply was associated with a 0.12 (95% CI: 0.11, 0.14) and 0.13 (95% CI: 0.07, 0.18) percentage-point higher increase in the probability of abandonment compared with patients with > 90 days of prior buprenorphine use. Among commercially insured and Medicare patients, buprenorphine prescription abandonment is rare and only minimally associated with cost-sharing. Findings suggest elimination of buprenorphine cost-sharing should only be one component of a larger, multi-faceted campaign to increase buprenorphine dispensing.

Sections du résumé

BACKGROUND BACKGROUND
Prior studies suggest cost-sharing decreases buprenorphine dispensing. However, these studies used databases that only report prescriptions filled by patients, not those that were "abandoned." Consequently, the studies could not calculate the probability of buprenorphine prescription abandonment or evaluate whether cost-sharing is associated with abandonment.
OBJECTIVE OBJECTIVE
To evaluate the association between cost-sharing and buprenorphine prescription abandonment.
DESIGN METHODS
Cross-sectional analysis of the IQVIA Formulary Impact Analyzer, a pharmacy transaction database representing 63% of U.S. retail pharmacies. The database includes transaction records ("claims") for prescriptions even if they are not filled.
PARTICIPANTS METHODS
Buprenorphine claims in 2022 among commercially insured and Medicare patients.
MAIN MEASURES METHODS
We evaluated the association between cost-sharing per 30-day supply and abandonment using logistic regression, controlling for patient characteristics, product type, and buprenorphine use in the prior 180 days. We assessed for effect modification by prior buprenorphine use.
KEY RESULTS RESULTS
Analyses included 2,346,994 and 1,242,596 buprenorphine prescription claims for commercially insured and Medicare patients, respectively. Among these claims, mean (SD) cost-sharing per 30-day supply was $28.1 (46.4) and $8.4 (20.2), and 1.5% and 1.2% were abandoned. Each $10 increase in cost-sharing per 30-day supply was associated with a 0.09 (95% CI: 0.09, 0.10) and 0.09 (95% CI: 0.08, 0.10) percentage-point increase in abandonment among commercially insured and Medicare patients. Among commercially insured and Medicare patients without prior buprenorphine use, respectively, a $10 increase in cost-sharing per 30-day supply was associated with a 0.12 (95% CI: 0.11, 0.14) and 0.13 (95% CI: 0.07, 0.18) percentage-point higher increase in the probability of abandonment compared with patients with > 90 days of prior buprenorphine use.
CONCLUSIONS CONCLUSIONS
Among commercially insured and Medicare patients, buprenorphine prescription abandonment is rare and only minimally associated with cost-sharing. Findings suggest elimination of buprenorphine cost-sharing should only be one component of a larger, multi-faceted campaign to increase buprenorphine dispensing.

Identifiants

DOI: 10.1007/s11606-024-08819-2 PMID: 38888865
pubmed: 38888865
doi: 10.1007/s11606-024-08819-2
pii: 10.1007/s11606-024-08819-2
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : NIDA NIH HHS
ID : R01DA056438-01
Pays : United States
Organisme : NIDA NIH HHS
ID : R01DA057284-01
Pays : United States
Organisme : NIDA NIH HHS
ID : K08DA048110-04
Pays : United States

Informations de copyright

© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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Auteurs

Kao-Ping Chua (KP)

Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA. chuak@med.umich.edu.
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA. chuak@med.umich.edu.
ORCID: 0000-0002-4081-272X

Rena M Conti (RM)

Department of Markets, Public Policy, And Law, Questrom School of Business, Boston University, Boston, MA, USA.

Pooja Lagisetty (P)

Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.

Amy S B Bohnert (ASB)

Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.

Usha Nuliyalu (U)

Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.

Thuy D Nguyen (TD)

Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.

Classifications MeSH