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

项目摘要 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。但只有 少数OUD患者开始治疗，早期停药是典型的，差异是地方性的。 残疾人面临的风险特别高，是开放式发展面临的多重挑战的缩影。 初步分析确定了医疗保险残疾受益人（MDB）中的45，035例致命阿片类药物过量 从2008年至2016年，以及持续的利用不足和MOUD的差异，包括过量用药 幸存者由于其在医疗保健系统中的广泛影响，医疗保险的作用至关重要;必须检查 医疗保险系统在吸引和留住医疗机构方面的成功和失败。最近的几 政策变化是有希望的，对其他支付者有重要影响，但它们对受益者的影响 需要更好地了解亚群体、时间和社区，以便为行动提供信息， 减少差距。本研究响应RFA-DA-22-037，将使用与 国家死亡指数，医疗补助索赔，社区资源，处方药计划（PDP）处方集政策， 和其他数据源，以评估政策、社区、提供者和患者因素如何相互作用，从而形成MOUD 开始和保留，进而过量和其他临床结果。随着2025年的年度更新， 该项目将提供一个强有力的框架，用于评估不断发展的治疗模式和结果， 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 获取方面的种族/民族和其他差异的驱动因素; MOUD随政策和处方集的变化而变化 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， 社区资源和患者特征。我们将分析MOUD治疗的趋势和差异 和过量用药的问题。在新的OUD诊断或非致命性过量的受益者队列中，我们 将评估与治疗开始和保持相关的因素，以及治疗与临床 结果包括非致死性和致死性过量。我们将评估MOUD在社区、供应商、 与转向远程保健相关的MOUD治疗模式的变化;以及 服务多边开发银行的MOUD治疗网络的相关变化。我们将研究变化的后遗症 在医疗保险的6000多个PDP的处方集政策中， MOUD，各受益人分组。扩大对远程MOUD的偿还，取消以前的 授权有可能挽救许多生命，但更好地了解其对获取的影响至关重要 和差异。在利益攸关方咨询委员会支持下的积极传播战略， 同行审查的出版物，将支持转化为循证政策。这一创新的成果， 全面评估多边开发银行采用MOUD和取得成果的多层次因素， 对患者亚组、支付方和医疗保健系统的政策和实践具有重要意义。

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.