Impact of Medicaid Prescription Cap Policies on Treatment Outcomes for Opioid Use Disorder: A National Mixed Methods Study
医疗补助处方上限政策对阿片类药物使用障碍治疗结果的影响:一项国家混合方法研究
基本信息
- 批准号:10637024
- 负责人:
- 金额:$ 77.16万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-04-01 至 2028-02-29
- 项目状态:未结题
- 来源:
- 关键词:AddressAdoptionAffectArkansasAttentionBudgetsBuprenorphineCaringCharacteristicsChronicClinicClinicalCost ControlDataDiagnosisDrug PrescriptionsEffectivenessElderlyEnrollmentEpidemiologistEquilibriumGeneral PopulationGoalsHIVHealthHealth Care CostsHealth PolicyHealth ServicesHospitalizationHospitalsImprove AccessIndividualInterviewKnowledgeLow incomeMedicaidMedicalMental HealthMental disordersMethadoneMethodsMorbidity - disease rateNaltrexoneNamesOpioidOutcomeOverdoseOverdose reductionPatientsPersonsPharmaceutical PreparationsPharmacistsPoliciesPopulationPrevalenceProcessProviderPublic HealthQualitative MethodsRecommendationResearchResearch PersonnelRiskSourceSubgroupTennesseeTexasTimeTreatment FailureTreatment outcomeUnited States National Institutes of HealthVulnerable Populationsaccess restrictionsbeneficiarychronic paincomorbiditycostdisabilityevidence baseexperiencehealth goalshealth service useimprovedmarginalized populationmedically necessary caremedication for opioid use disordermethadone treatmentmortalitynovelopioid epidemicopioid mortalityopioid use disorderoverdose deathpopulation healthprogramsresponsesevere mental illnessskillsuptakeyoung adult
项目摘要
PROJECT SUMMARY
More than 2 million people have opioid use disorder (OUD) in the U.S. and opioids accounted for 70% of the
nearly 100,000 drug-overdose deaths in 2020. Increasing OUD prevalence and opioid-involved overdose deaths
underscore the urgent need for improved access to effective OUD treatments. Methadone, buprenorphine, and
naltrexone are effective in treating OUD, yet these medications for OUD (MOUD) are underutilized, particularly
among low-income Medicaid beneficiaries who represent a sizable portion of the U.S. population living with OUD.
Prescription (Rx) caps represent a cost-containment strategy employed by some state Medicaid programs that
limit the number of brand name drugs or total number of prescriptions that may be filled each month. Rx cap
policies potentially exacerbate the opioid epidemic by impeding access to MOUD among financially constrained
Medicaid beneficiaries, many of whom have comorbid chronic health conditions (e.g., mental illness, chronic
pain, HIV), and who are forced to make tradeoffs between which medically necessary medications to fill. Though
a few older studies have used Medicaid data to evaluate the impact of Rx caps on the health of the general
population, until now, this has not been studied among people with OUD – an NIH priority population. The
objective of this application is to examine whether and how Medicaid Rx caps affect the care and health of people
with OUD and other chronic health conditions. Our long-term research goal is to develop an evidence base that
can be used to revise medication utilization management policies in ways that balance budget priorities with
improved patient and population health outcomes. Our central hypothesis is that Rx caps contribute to reduced
uptake of and continuity with MOUD treatment, resulting in increased overdoses and mortality. The rationale for
this hypothesis is that people with OUD frequently have co-occurring conditions and are likely to require several
simultaneous prescriptions to manage their health, placing them at risk for exceeding the caps. Our skilled team
of health services researchers, pharmacists, clinicians, and epidemiologists has extensive experience using
Medicaid claims data and qualitative methods to study the impact of health policies on marginalized populations.
We propose to analyze national Medicaid data to evaluate the impact of Rx cap policies on initiation and
continuity of MOUD use among individuals diagnosed with OUD; and determine the impact of Rx cap policies
on health services utilization, overdoses, and all-cause mortality among this population. We will then
contextualize our quantitative findings via interviews with patients with OUD and providers who practice in states
impacted by cap policies to elucidate their experiences with caps and identify best practices for navigating these
policies. Completion of this research will help to close critical knowledge gaps by generating novel mixed-method
findings on Rx drug coverage for OUD treatment and yield best-practice recommendations for navigating cap
policies. As states continue to consider strategies to address the worsening opioid and overdose crises, due
attention should be given to Medicaid benefit restrictions that can undermine individual and public health goals.
项目摘要
在美国,超过200万人患有阿片类药物使用障碍(OUD),阿片类药物占70%。
2020年将有近10万人死于药物过量。OUD患病率增加和阿片类药物过量死亡
强调迫切需要改善获得有效的OUD治疗。美沙酮丁丙诺啡
纳洛酮在治疗OUD方面是有效的,但这些治疗OUD(MOUD)的药物未得到充分利用,特别是
在低收入医疗补助受益人中,他们代表了美国OUD人口的相当大一部分。
处方(Rx)上限代表了一些州医疗补助计划采用的成本控制策略,
限制品牌药品的数量或每月可以填写的处方总数。Rx帽
政策可能会通过阻碍财政拮据的人获得MOUD而加剧阿片类药物的流行
医疗补助受益人,其中许多人患有慢性健康状况(例如,慢性精神病
疼痛,艾滋病毒),以及被迫在填充哪些医学上必要的药物之间做出权衡的人。虽然
一些较早的研究使用医疗补助数据来评估Rx上限对一般人群健康的影响。
到目前为止,这还没有在OUD患者中进行研究-NIH优先人群。的
本申请的目的是检查Medicaid Rx上限是否以及如何影响人们的护理和健康
OUD和其他慢性健康状况。我们的长期研究目标是建立一个证据基础,
可用于修订药物利用管理政策,以平衡预算优先级,
改善患者和人群的健康状况。我们的中心假设是,Rx帽有助于减少
MOUD治疗的吸收和连续性,导致过量和死亡率增加。的理由
这一假设是,患有OUD的人经常同时患有多种疾病,并且可能需要多种治疗
同时开处方来管理他们的健康,使他们面临超过上限的风险。我们的专业团队
的卫生服务研究人员,药剂师,临床医生和流行病学家有丰富的经验,
医疗补助要求数据和定性方法来研究卫生政策对边缘化人群的影响。
我们建议分析国家医疗补助数据,以评估处方上限政策对启动和
在诊断为OUD的个体中使用MOUD的连续性;并确定Rx上限政策的影响
关于这一人群的卫生服务利用、过量用药和全因死亡率。然后我们将
通过与OUD患者和在各州执业的提供者的访谈,将我们的定量研究结果置于情境中
受上限政策的影响,阐明其在上限方面的经验,并确定引导这些政策的最佳做法。
施政纲要而这项研究的完成将有助于通过产生新的混合方法来缩小关键知识差距
关于OUD治疗的Rx药物覆盖率的调查结果,并为导航帽提供最佳实践建议
施政纲要而随着各州继续考虑解决日益恶化的阿片类药物和过量危机的战略,
应注意可能损害个人和公共健康目标的医疗补助福利限制。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Patience Moyo Dow其他文献
Patience Moyo Dow的其他文献
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{{ truncateString('Patience Moyo Dow', 18)}}的其他基金
Skilled Nursing Facility Care and Outcomes After Hospitalizations Involving Opioid Use Disorder
涉及阿片类药物使用障碍的住院后熟练护理机构的护理和结果
- 批准号:
10371281 - 财政年份:2022
- 资助金额:
$ 77.16万 - 项目类别:
Skilled Nursing Facility Care and Outcomes After Hospitalizations Involving Opioid Use Disorder
涉及阿片类药物使用障碍的住院后熟练护理机构的护理和结果
- 批准号:
10609800 - 财政年份:2022
- 资助金额:
$ 77.16万 - 项目类别:
Chronic Pain Management and Outcomes in Adults With and Without Opioid Use Disorder
有和没有阿片类药物使用障碍的成年人的慢性疼痛管理和结果
- 批准号:
10302666 - 财政年份:2021
- 资助金额:
$ 77.16万 - 项目类别:
Chronic Pain Management and Outcomes in Adults With and Without Opioid Use Disorder
有和没有阿片类药物使用障碍的成年人的慢性疼痛管理和结果
- 批准号:
10434917 - 财政年份:2021
- 资助金额:
$ 77.16万 - 项目类别:
Trends and racial/ethnic differences in opioid prescribing safety and use of nonpharmacologic treatments for chronic pain in adults with co-occurring opioid use disorder
患有并发阿片类药物使用障碍的成人慢性疼痛的阿片类药物处方安全性和非药物治疗使用的趋势和种族/民族差异
- 批准号:
10666622 - 财政年份:2019
- 资助金额:
$ 77.16万 - 项目类别:
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