Association between state Medicaid expansion status and naloxone prescription dispensing
Association between state Medicaid expansion status and naloxone prescription dispensing
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DOI：
10.1111/1475-6773.13266
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发表时间：
2020-02-07
影响因子：
3.4
通讯作者：
Freeman, Patricia R.
中科院分区：
文献类型：
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作者：
Sohn, Minji;Talbert, Jeffery C.;Freeman, Patricia R.
Objective To test whether Medicaid expansion is associated with（a）a greater number of naloxone prescriptions dispensed and（B）a higher proportion of naloxone prescriptions payed by Medicaid.数据来源/研究设置我们使用IQVIA National Prescription Audit来获得2011- 16年期间每个州每个季度的纳洛酮处方分配数据。使用差分估计模型检查医疗补助扩展对纳洛酮处方分配的影响。国家级协变量，包括基于药物的纳洛酮法律（常设/协议命令和直接权力分配纳洛酮），第三方处方法，阿片类镇痛药处方率，阿片类药物涉及的过量死亡率，和人口规模进行了控制的分析。主要发现医疗补助扩张与38个额外的纳洛酮处方分配每个州每季度相比，非扩张控制，平均值（P = 0.030）。此外，医疗补助的扩大导致每个州每季度医疗补助支付的纳洛酮处方份额平均增加9.86%（P < .001）。这一发现表明，在做出影响医疗补助覆盖范围的联邦和州一级决定时，考虑纳洛酮的使用是很重要的。
Objective To test whether Medicaid expansion is associated with (a) a greater number of naloxone prescriptions dispensed and (b) a higher proportion of naloxone prescriptions paid by Medicaid.Data Sources/Study Setting We used the IQVIA National Prescription Audit to obtain data on per state per quarter naloxone prescription dispensing for the period 2011-16.Study Design In this quasi-experimental design study, the impact of Medicaid expansion on naloxone prescription dispensing was examined using difference-in-difference estimation models. State-level covariates including pharmacy-based naloxone laws (standing/protocol orders and direct authority to dispense naloxone), third-party prescribing laws, opioid analgesic prescribing rates, opioid-involved overdose death rates, and population size were controlled for in the analysis.Principal Findings Medicaid expansion was associated with 38 additional naloxone prescriptions dispensed per state per quarter compared to nonexpansion controls, on average (P = .030). Also, Medicaid expansion resulted in an average increase of 9.86 percent in the share of naloxone prescriptions paid by Medicaid per state per quarter (P < .001).Conclusions Our study found that Medicaid expansion increased naloxone availability. This finding suggests that it will be important to consider naloxone access when making federal- and state-level decisions affecting Medicaid coverage.