The association of Medicare Part D prior authorization for buprenorphine-naloxone with adherence to opioid use disorder treatment guidelines in the United States
The association of Medicare Part D prior authorization for buprenorphine-naloxone with adherence to opioid use disorder treatment guidelines in the United States
复制标题
DOI：
10.1111/add.15585
复制
发表时间：
2021-06-14
期刊：
影响因子：
6
通讯作者：
Weber, Ellen
中科院分区：
文献类型：
--
作者：
Parish, William J.;Mark, Tami L.;Weber, Ellen
目的评估阿片类药物使用障碍（OUD）治疗的质量的差异，医疗保险受益人参加的健康计划，使用事先授权（PA）的丁丙诺啡-纳洛酮与那些参加计划，不使用PA。设计，设置和参与者的横断面观察性研究，美国。在2012年3月至2017年7月期间连续入组的OUD受益人（71 294），他们至少填写了一份丁丙诺啡-纳洛酮处方。测量接受B型肝炎、丙型肝炎、HIV和肝功能检测的患者百分比;接受尿液药物筛查的患者百分比和尿液药物筛查次数;连续使用丁丙诺啡-纳洛酮至少180天;苯并二氮杂卓类药物的合并使用;结果PA与较低的检测B型肝炎的可能性显著相关[-3.5，95%可信区间（CI）=-4.4，-2.7]，C型肝炎的可能性显著相关（-5.9，95%CI =-6.9，-4.9），但对于HIV是否存在差异，研究结果尚无定论（-1.1，95%CI =-2.5，0.4）或肝功能检查（1.3，95%CI =-0.1，2.7）。PA与尿液药物筛查的可能性较低（-25.5，95% CI =-26.8，-24.1）和药物筛查次数较少（-2.5，95% CI =-3.0，-2.1）相关。对于连续使用丁丙诺啡-纳洛酮是否存在差异，结果尚不确定（0.3，95% CI =-1.2，1.8）。PA与较少的门诊访视（-2.1，95% CI =-3.0，-1.2）和较少的OUD诊断门诊访视（-1.7，95% CI =-2.1，-1.3）相关。PA与丁丙诺啡-纳洛酮诱导前后填写苯二氮卓类处方的可能性较低相关（-28.9，95% CI =-29.6，-28.3），但在丁丙诺啡-纳洛酮诱导后仅使用苯二氮卓类药物的可能性更大（10.6，95% CI = 9.3，11.8）。结论：接受丁丙诺啡-纳洛酮事先授权的美国医疗保险患者接受高剂量阿片类药物使用障碍的治疗质量高于未经事先授权的患者。
Aims To assess differences in the quality of opioid use disorder (OUD) treatment received by Medicare beneficiaries enrolled in health plans that used prior authorization (PA) for buprenorphine-naloxone compared with those enrolled in plans that did not use PA.Design, Setting and Participants Cross-sectional observational study, United States. Continuously enrolled beneficiaries (71 294) with an OUD who filled at least one prescription for buprenorphine-naloxone between March 2012 and July 2017.Measurements Percentage of patients tested for hepatis B, hepatis C, HIV and liver functioning; percentage of patients with urine drug screens and number of urine drug screens; continuous use of buprenorphine-naloxone for at least 180 days; co-use of benzodiazepines; number of outpatient visits with and without an OUD diagnosis.Findings PA was significantly associated with a lower likelihood of testing for hepatitis B [-3.5, 95% confidence interval (CI) = -4.4, -2.7] and C (-5.9, 95% CI = -6.9, -4.9), but the findings were inconclusive as to whether or not there was a difference in HIV (-1.1, 95% CI = -2.5, 0.4) or liver function testing (1.3, 95% CI = -0.1, 2.7). PA was associated with a lower likelihood of urine drug screening (-25.5, 95% CI = -26.8, -24.1) and with fewer drug screens (-2.5, 95% CI = -3.0, -2.1). Findings were inconclusive as to whether or not there was a difference in continuous use of buprenorphine-naloxone (0.3, 95% CI = -1.2, 1.8). PA was associated with fewer outpatient visits (-2.1, 95% CI = -3.0, -1.2) and fewer outpatient visits with an OUD diagnosis (-1.7, 95% CI = -2.1, -1.3). PA was associated with a lower likelihood of filling benzodiazepine prescriptions before and after buprenorphine-naloxone induction (-28.9, 95% CI = -29.6, -28.3) but a greater likelihood of only using benzodiazepines after buprenorphine-naloxone induction (10.6, 95% CI = 9.3, 11.8).Conclusions US Medicare patients subject to prior authorization for buprenorphine-naloxone are not more likely to receive high-quality treatment for opioid use disorder than patients not subject to prior authorization.