Policies related to opioid agonist therapy for opioid use disorders: The evolution of state policies from 2004 to 2013.
Policies related to opioid agonist therapy for opioid use disorders: The evolution of state policies from 2004 to 2013.
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DOI：
10.1080/08897077.2015.1080208
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发表时间：
2016
期刊：
影响因子：
3.5
通讯作者：
Stein BD
中科院分区：
文献类型：
--
作者：
Burns RM;Pacula RL;Bauhoff S;Gordon AJ;Hendrikson H;Leslie DL;Stein BD
国家医疗补助政策在医疗补助参保人获得和使用阿片类激动剂（如美沙酮和丁丙诺啡）治疗阿片类药物使用障碍方面发挥着重要作用。然而，关于国家政策的演变促进或阻碍获得阿片类激动剂的医疗保险参保人的信息很少。在2013-14年期间，我们调查了州医疗补助官员和其他指定的州药物滥用治疗专家，了解他们州最近的医疗补助覆盖历史以及与美沙酮和丁丙诺啡有关的政策。我们描述了这种覆盖范围和政策的演变，并概述了2004年至2013年关于阿片类激动剂治疗的医疗补助政策环境。在我们的样本中，有丁丙诺啡和美沙酮覆盖信息的45个州中，我们发现在州医疗补助机构中采用阿片类激动剂治疗的覆盖逐渐呈趋势。2013年，在我们的样本中，只有11%的州（n=5）的医疗补助政策不包括美沙酮和丁丙诺啡，而71% （n=32）的医疗补助参保人采用或维持了包括丁丙诺啡和美沙酮的政策。我们还注意到，在这段时间内，政策的增加可能阻碍了丁丙诺啡和/或美沙酮的获取。各州似乎有一种趋势，即制定政策增加阿片类激动剂治疗的医疗补助覆盖范围，而近年来也制定了政策，如事先授权要求，这可能成为阿片类激动剂治疗使用的障碍。关于此类政策的潜在利益和潜在意外后果的更多经验信息可以使政策制定者和其他人对其政策决定有更充分的了解。
State Medicaid policies play an important role in Medicaid-enrollees' access to and use of opioid agonists, such as methadone and buprenorphine, in the treatment of opioid use disorders. Little information is available, however, regarding the evolution of state policies facilitating or hindering access to opioid agonists among Medicaid-enrollees. During 2013-14, we surveyed state Medicaid officials and other designated state substance abuse treatment specialists about their state's recent history of Medicaid coverage and policies pertaining to methadone and buprenorphine. We describe the evolution of such coverage and policies and present an overview of the Medicaid policy environment with respect to opioid agonist therapy from 2004 to 2013. Among our sample of 45 states with information on buprenorphine and methadone coverage, we found a gradual trend toward adoption of coverage for opioid agonist therapies in state Medicaid agencies. In 2013, only 11% of states in our sample (n=5) had Medicaid policies that excluded coverage for methadone and buprenorphine, while 71% (n=32) had adopted or maintained policies to cover both buprenorphine and methadone among Medicaid-enrollees. We also noted an increase in policies over the time period that may have hindered access to buprenorphine and/or methadone. There appears to be a trend for states to enact policies increasing Medicaid coverage of opioid agonist therapies, while in recent years also enacting policies, such as prior authorization requirements, that potentially serve as barriers to opioid agonist therapy utilization. Greater empirical information about the potential benefits and potential unintended consequences of such policies can provide policymakers and others with a more informed understanding of their policy decisions.