Coverage and Prior Authorization Policies for Medications for Opioid Use Disorder in Medicaid Managed Care.
Coverage and Prior Authorization Policies for Medications for Opioid Use Disorder in Medicaid Managed Care.
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DOI：
10.1001/jamahealthforum.2022.4001
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发表时间：
2022-11-04
期刊：
影响因子：
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通讯作者：
Grogan, Colleen M
中科院分区：
文献类型：
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作者：
Abraham, Amanda J;Andrews, Christina M;Harris, Samantha J;Westlake, Melissa M;Grogan, Colleen M
医疗补助是改善阿片类药物使用障碍治疗的关键政策杠杆，覆盖了大约40%的阿片类药物使用障碍美国人。虽然大约70%的医疗补助受益人参加了综合管理护理组织（MCO）计划，但对这些计划中阿片类药物使用障碍（MOUD）的覆盖范围和事先授权（PA）政策知之甚少。比较Medicaid MCO计划和收费服务（FFS）计划以及各州的丁丙诺啡，美沙酮和注射纳洛酮的覆盖范围和PA政策。这项横断面研究分析了2018年38个州和哥伦比亚特区的266个Medicaid MCO计划和FFS计划的MOUD数据。对于每种药物，计算了MCO计划和FFS计划中覆盖无PA药物、覆盖有PA药物和不覆盖药物的百分比，以及MCO、FFS和所有（MCO和FFS）受益人中覆盖无PA、覆盖有PA和不覆盖的百分比。此外，MCO计划覆盖范围和PA政策按州绘制。分析于2022年1月1日至5月31日进行。在266个MCO计划和39个FFS计划中比较了MOUD的覆盖范围和PA政策，代表了大约7000万医疗补助受益人。总的来说，FFS计划比MCO计划有更慷慨的MOUD覆盖面。然而，FFS计划对3种药物实施PA的百分比（47.0%）高于MCO（35.9%）。此外，尽管大多数医疗补助受益人参加了涵盖MOUD的计划，但所有MCO和FFS参加的受益人中有53.2%受到PA的影响。结果还显示，在MCO计划覆盖面和PA政策的MOUD和受PA的医疗补助受益人的百分比广泛的状态变化。这项横断面研究发现，医疗补助MCO计划和FFS计划以及各州的MOUD覆盖范围和PA政策存在差异。因此，医疗补助受益人对MOUD的访问可能会受到他们居住状态和他们参加的医疗补助计划的严重影响。如果不加以解决，巴勒斯坦权力机构的政策很可能仍然是一个障碍，以MOUD获得在国家的医疗补助计划。
Medicaid is a key policy lever to improve opioid use disorder treatment, covering approximately 40% of Americans with opioid use disorder. Although approximately 70% of Medicaid beneficiaries are enrolled in comprehensive managed care organization (MCO) plans, little is known about coverage and prior authorization (PA) policies for medications for opioid use disorder (MOUD) in these plans. To compare coverage and PA policies for buprenorphine, methadone, and injectable naltrexone across Medicaid MCO plans and fee-for-service (FFS) programs and across states. This cross-sectional study analyzed MOUD data from 266 Medicaid MCO plans and FFS programs in 38 states and the District of Columbia in 2018. For each medication, the percentages of MCO plans and FFS programs that covered the medication without PA, covered the medication with PA, and did not cover the medication were calculated, as were the percentages of MCO, FFS, and all (MCO and FFS) beneficiaries who were covered with no PA, covered with PA, and not covered. In addition, MCO plan coverage and PA policies were mapped by state. Analyses were conducted from January 1 through May 31, 2022. Coverage and PA policies were compared for MOUD in 266 MCO plans and 39 FFS programs, representing approximately 70 million Medicaid beneficiaries. Overall, FFS programs had more generous MOUD coverage than MCO plans. However, a higher percentage of FFS programs imposed PA for the 3 medications (47.0%) than did MCOs (35.9%). Furthermore, although most Medicaid beneficiaries were enrolled in a plan that covered MOUD, 53.2% of all MCO- and FFS-enrolled beneficiaries were subject to PA. Results also showed wide state variation in MCO plan coverage and PA policies for MOUD and the percentage of Medicaid beneficiaries subject to PA. This cross-sectional study found variation in MOUD coverage and PA policies across Medicaid MCO plans and FFS programs and across states. Thus, Medicaid beneficiaries’ access to MOUD may be heavily influenced by their state of residency and the Medicaid plan in which they are enrolled. Left unaddressed, PA policies are likely to remain a barrier to MOUD access in the nation’s Medicaid programs.