Insurance-related barriers to medications for opioid use disorder in private and Medicaid plans

项目摘要 2020年，美国发生了创纪录的71，000例阿片类药物过量死亡。 丁丙诺啡，美沙酮和缓释纳洛酮，三种FDA批准的 阿片类药物使用障碍（MOUD）。尽管如此，许多阿片类药物使用障碍（OUD）患者从未 开始MOUD治疗，而那些经常放弃治疗的人，增加了他们的死亡风险。 虽然没有保险的人在OUD患者中比例过高，但私人保险和医疗补助 患者占非老年美国OUD患者的四分之三，这表明减轻OUD的障碍 在这些患者中使用MOUD是一个特别重要的目标。在众多此类障碍中，与保险有关的 障碍是一个有吸引力的干预目标，因为保险福利设计直接受 政策制定者、保险公司和雇主。然而，与保险有关的障碍对MOUD使用的影响， 私人保险和医疗补助的病人还没有得到严格的研究。因此，尚不清楚哪些 在政策干预中应针对各种障碍，并应如何设计这些干预。在这 根据这一建议，我们将提供可操作的、与政策相关的信息，说明发展模式费用分摊的影响， 私人保险患者以及取消医疗补助中MOUD的事先授权要求的影响 患者为此，我们将分析来自几个最先进的国家数据库的2017-2023年数据，包括 来自92%的美国药房的处方配药数据，药房交易数据库捕获63% 5500万美国人的商业索赔，100%的医疗补助索赔， states.分析将侧重于15-64岁的患者，这一年龄组占美国阿片类药物的96% 过量死亡在目标1中，我们将评估成本分摊与MOUD风险之间的关联 私人保险患者的处方不配药，包括总体和关键患者亚组， 开始MOUD治疗的人一样。此外，我们将使用商业索赔数据库来评估 MOUD费用分摊与私人保险患者中阿片类药物过量风险之间的关联。在目标2中， 我们将使用差异中的差异模型、国家药房数据库和医疗补助索赔来评估 取消医疗补助计划中MOUD事先授权要求的州政策是否 与MOUD分发、MOUD治疗保留和阿片类药物过量风险的变化相关， 医疗补助病人。该提案的调查结果将为优化保险福利设计提供信息和激励 私人和医疗补助计划中的MOUD，可能导致消除与保险相关的障碍， 可能导致类阿片相关发病率和死亡率上升。

PROJECT SUMMARY In 2020, a record 71,000 opioid overdose deaths occurred in the U.S. The number of such deaths can be reduced by buprenorphine, methadone, and extended-release naltrexone, the three FDA-approved medications for opioid use disorder (MOUD). Despite this, many patients with opioid use disorder (OUD) never initiate treatment with MOUD, and those that do often drop out of treatment, increasing their risk of death. Although the uninsured are over-represented among patients with OUD, privately insured and Medicaid patients represent three-quarters of non-elderly Americans with OUD, suggesting that mitigating barriers to MOUD use in these patients is an especially important goal. Among the many such barriers, insurance-related barriers are an appealing target for intervention, as insurance benefit design is directly under the control of policymakers, insurers, and employers. However, the effects of insurance-related barriers on MOUD use in privately insured and Medicaid patients have not been rigorously studied. Consequently, it is unclear which barriers should be targeted in policy interventions and how these interventions should be designed. In this proposal, we will provide actionable, policy-relevant information on the effect of cost-sharing for MOUD in privately insured patients and on the effect of removing prior authorization requirements for MOUD in Medicaid patients. To do so, we will analyze 2017-2023 data from several state-of-the-art national databases, including prescription dispensing data from 92% of U.S. pharmacies, a pharmacy transactions database capturing 63% of U.S. prescription volume, commercial claims from 55 million Americans, and 100% Medicaid claims from all states. Analyses will focus on patients aged 15-64 years, an age group accounting for 96% of U.S. opioid overdose deaths. In Aim 1, we will evaluate the association between cost-sharing and the risk of MOUD prescription non-dispensing in privately insured patients, both overall and among key patient subgroups, such as those initiating MOUD therapy. Additionally, we will use the commercial claims database to evaluate the association between cost-sharing for MOUD and opioid overdose risk in privately insured patients. In Aim 2, we will use difference-in-differences models, national pharmacy databases, and Medicaid claims to evaluate whether state policies eliminating prior authorization requirements for MOUD in Medicaid plans were associated with changes in MOUD dispensing, retention in MOUD therapy, and opioid overdose risk in Medicaid patients. Findings from this proposal will inform and spur efforts to optimize insurance benefit design for MOUD in private and Medicaid plans, potentially leading to the removal of insurance-related barriers that may be contributing to rising opioid-related morbidity and mortality.