Changes in Buprenorphine-Naloxone and Opioid Pain Reliever Prescriptions After the Affordable Care Act Medicaid Expansion
Changes in Buprenorphine-Naloxone and Opioid Pain Reliever Prescriptions After the Affordable Care Act Medicaid Expansion
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DOI：
10.1001/jamanetworkopen.2018.1588
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发表时间：
2018-08-01
影响因子：
13.8
通讯作者：
Alexander, G. Caleb
中科院分区：
文献类型：
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作者：
Saloner, Brendan;Levin, Jonathan;Alexander, G. Caleb
重要性扩大医疗补助资格可能会影响丁丙诺啡与纳洛酮的处方，这是阿片类药物使用障碍的一种既定治疗方法，以及阿片类止痛药（OPRs）。目的研究美国平价医疗法案医疗补助扩大后丁丙诺啡与纳洛酮和OPRs处方的变化。零售药店声明是从匿名、纵向处方数据库中的IQVIA真实数据中提取的。该样本包括1190万人，他们在2010年1月1日之间的至少1年内填写了2张或更多处方阿片类药物处方。2015年12月31日，来自加州、马里兰州和华盛顿（扩张州）以及佛罗里达和格鲁吉亚（非扩张州）。数据分析于2017年8月1日至2018年5月31日进行。数据汇总到县一年的观察（N = 2082），并与县级协变量。对于每一个结果，一个差异中的差异回归模型进行了估计，比较了扩张前后与非扩张县的变化。模型进行调整县人口统计，无保险率，过量死亡率在基线年（2010）。EXPOSURES存在的医疗补助expansion in the year.Main OUTCOMES AND MEASURES对于丁丙诺啡与纳洛酮和OPR，每100 000县居民率分别计算任何处方的整体和不同的支付来源。结果研究样本包括1190万人（扩展状态：40.9%男性;平均[SD]年龄，44.1 [13.8]岁;非扩展状态：41.0%男性;平均[SD]年龄，43.7 [13.7]岁）。在扩展县，2010年每10万县居民中有68.8人使用纳洛酮填充丁丙诺啡，5298.3人使用OPR处方。扩展后，每10万名县居民的丁丙诺啡与纳洛酮填充量在扩展中相对于非扩展县显著增加（8.7; 95%CI，1.7至15.7）。相对于非扩张县，扩张县每10万县居民的阿片类止痛药填充量没有显著变化（327.4; 95% CI -202.5至857.4）。医疗补助支付的每10万县居民的OPR率显著增加（374.0; 95%CI，258.3至489.7）。每100 000县居民的天没有显着的变化，无论是药物expansions.CONCLUSIONS和相关性医疗补助扩张显着增加丁丙诺啡与纳洛酮处方每100 000县居民在扩张县，这表明扩大改善获得阿片类药物使用障碍治疗。扩大并没有显着增加每10万县居民的OPR处方的总体比率，但增加了由医疗补助支付的OPR的人口。因此，这一发现表明医疗补助在疼痛管理和成瘾预防方面的重要性日益增加。
IMPORTANCE Expanding Medicaid eligibility could affect prescriptions of buprenorphine with naloxone, an established treatment for opioid use disorder, and opioid pain relievers (OPRs).OBJECTIVE To examine changes in prescriptions of buprenorphine with naloxone and OPRs after the US Affordable Care Act Medicaid expansion.DESIGN, SETTING, AND PARTICIPANTS In this cohort study, longitudinal, patient-level, retail pharmacy claims were extracted from IQVIA real-world data from an anonymized, longitudinal, prescription database. The sample included 11.9 million individuals who filled 2 or more prescriptions for a prescription opioid during at least 1 year between January 1, 2010. and December 31, 2015, from California, Maryland, and Washington (expansion states) and Florida and Georgia (nonexpansion states). Data analysis was conducted from August 1, 2017, to May 31, 2018. Data were aggregated to county-year observations (N = 2082) and linked to county-level covariates. For each outcome, a difference-in-differences regression model was estimated comparing changes before and after expansion in expansion vs nonexpansion counties. Models were adjusted for county demographics, uninsured rate, and overdose mortality in the baseline year (2010).EXPOSURES Presence of Medicaid expansion in the year.MAIN OUTCOMES AND MEASURES For buprenorphine with naloxone and OPRs, rates per 100 000 county residents were calculated separately for any prescriptions overall and by different payment sources. Mean days of medication per county among people filling prescriptions for these agents were also determined.RESULTS The study sample included 11.9 million individuals (expansion states: 40.9% men; mean [SD] age, 44.1 [13.8] years; nonexpansion states: 41.0% men; mean [SD] age, 43.7 [13.7] years). In expansion counties, 68.8 individuals per 100 000 county residents filled buprenorphine with naloxone and 5298.3 filled OPR prescriptions in 2010. After expansion, buprenorphine with naloxone fills per 100 000 county residents increased significantly in expansion relative to nonexpansion counties (8.7; 95% CI, 1.7 to 15.7). Opioid pain reliever fills per 100 000 county residents did not significantly change in expansion counties relative to nonexpansion counties (327.4; 95% CI -202.5 to 857.4). The rate of OPRs per 100 000 county residents paid for by Medicaid significantly increased (374.0; 95% CI, 258.3 to 489.7). There were no significant changes in days per 100 000 county residents of either medication after expansion.CONCLUSIONS AND RELEVANCE Medicaid expansion significantly increased buprenorphine with naloxone prescriptions per 100 000 county residents in expansion counties, suggesting that expansion improved access to opioid use disorder treatment. Expansion did not significantly increase the overall rate per 100 000 county residents of OPR prescriptions, but increased the population with OPRs paid for by Medicaid. This finding therefore suggests the growing importance of Medicaid in pain management and addiction prevention.