Improving MOUD Access, Opioid-Related Outcomes and Equity Among Medicare Beneficiaries with Disability

项目摘要 治疗阿片类药物使用障碍(MOUD)是减少阿片类药物流行危害的关键工具。然而，只有 少数OUD患者开始治疗，早期停药是典型的，差异是地方性的。 残疾人的风险特别高，是多发病OUD挑战的缩影。 初步分析发现，在医疗保险残疾受益人(MDB)中有45,035人服用致命的阿片类药物过量 从2008年到2016年，Moud持续利用不足和差距，包括服药过量 幸存者。由于其在医疗保健系统中的广泛影响，医疗保险的作用是至关重要的；必须审查 医疗保险系统在吸引和留住多边开发银行进行治疗方面的成功和失败。最近的几个 政策变化是有希望的，对其他支付者具有重要影响，但它们对所有受益者都有影响 需要更好地了解小组、时间和社区，以指导采取行动，提高吸纳率和 缩小差距。这项研究响应RFA-DA-22-037，将使用与 国家死亡指数，医疗补助申请，社区资源，处方药计划(PDP)处方政策， 和其他数据源，以评估政策、社区、提供商和患者因素如何相互作用来塑造Moud 开始和保留，进而过量用药和其他临床结果。到2025年的年度更新， 该项目将为评估不断演变的治疗模式和结果提供一个强大的框架 快速变化的环境，以及随着时间的推移政策影响的潜在变化。我们将评估 种族/族裔和其他机会差距的驱动因素；随着政策和规定的变化而变化 医疗保险及其PDP；以及这些政策如何与不断发展的Moud提供者系统相互作用， 社区资源和患者特点。我们将分析Moud治疗的趋势和差距 以及多边开发银行中的过量使用。在患有新的OUD诊断或非致命性过量用药的受益人队列中，我们 将评估与治疗开始和保留相关的因素，以及治疗与临床的联系 结果包括非致命和致命的过量用药。我们将评估社区、提供商、 和患者分组；与向远程医疗转变相关的Moud治疗模式的变化；以及 为多边开发银行提供服务的Moud治疗网络的相关变化。我们将研究变化的后遗症 在联邦医疗保险6000多个PDP的处方政策中，包括以下方面的事先授权要求 穆德，跨受益子群体。扩大了对电视广播的报销范围，并取消了之前的报销 授权有可能挽救许多人的生命，但更好地了解它们对访问的影响至关重要 和差距。利益攸关方咨询委员会支持的积极传播战略，补充 经同行评审的出版物，将支持将其转化为循证政策。这一创新和 综合评估影响多边开发银行对多氯联苯的吸收和成果的多层次因素 对患者亚群、付款人和医疗保健系统的政策和实践具有重要影响。

PROJECT ABSTRACT Medications for opioid use disorder (MOUD) are a key tool in reducing harms of the opioid epidemic. Yet only a minority of those with OUD initiate treatment, early discontinuation is typical, and disparities are endemic. People with disabilities are at especially high risk and epitomize the challenges of OUD with multimorbidity. Preliminary analyses identified 45,035 fatal opioid overdoses among Medicare disability beneficiaries (MDBs) from 2008-2016, and continuing under-utilization and disparities in MOUD, including among overdose survivors. With its wide influence in the health care system, Medicare's role is vital; it is essential to examine the Medicare system's successes and failures in engaging and retaining MDBs in treatment. Several recent policy changes are promising, with important implications for other payers, but their impact across beneficiary subgroups, time and communities needs to be better understood to inform action to improve uptake and reduce disparities. This study, responding to RFA-DA-22-037, will use national Medicare data linked with the National Death Index, Medicaid claims, community resources, prescription drug plan (PDP) formulary policies, and other data sources to assess how policy, community, provider and patient factors interact to shape MOUD initiation and retention, and in turn overdose and other clinical outcomes. With annual updates through 2025, the project will provide a powerful framework for assessing evolving treatment patterns and outcomes in a rapidly evolving environment, as well as potential changes in policy impacts over time. We will assess the drivers of racial/ethnic and other disparities in access; MOUD changes following policy and formulary changes by Medicare and its PDPs; and how these policies interact with the evolving MOUD provider system, community resources and patient characteristics. We will analyze trends and disparities in MOUD treatment and overdoses among MDBs. In cohorts of beneficiaries with new OUD diagnoses or non-fatal overdoses, we will assess factors associated with treatment initiation and retention, and association of treatment with clinical outcomes including non-fatal and fatal overdose. We will assess MOUD uptake across community, provider, and patient subgroups; changes in MOUD treatment patterns associated with the shift to tele-health; and associated changes in the MOUD treatment network serving MDBs. We will examine the sequelae of changes in formulary policies across Medicare's more than 6000 PDPs, including prior authorization requirements for MOUD, across beneficiary subgroups. Expanded reimbursement for tele-MOUD and elimination of prior authorization have the potential to save many lives, but it is critical to better understand their impact on access and disparities. An active dissemination strategy supported by a Stakeholder Advisory Board, complementing peer-reviewed publication, will support translation into evidence-informed policy. Results of this innovative and comprehensive assessment of the multi-level factors shaping MOUD uptake and outcomes among MDBs will have important implications for policy and practice across patient subgroups, payers and health care systems.