Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017

Dados Bibliográficos

ID9100764
AutoresHaiden A Huskamp (0000-0002-1860-3956, Harvard Medical School, autor correspondente), Lauren E Riedel (Harvard Medical School), Lauren Riedel (Harvard University, autor correspondente), Colleen L Barry (0000-0001-8211-5036, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD), Alisa B Busch (0000-0002-1828-9098, McLean Hospital, Belmont, MA)
Ano2018
Volume56
Fascículo6
Páginas505-509
Data de publicação2018-06-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Care (JOURNAL)
Identificadores do periódicoISSN: 0025-7079 • E-ISSN: 1537-1948
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000918
PMID29668645
OpenAlexW2800476884
IdiomaEN
Citações recebidas6
Referências citadas14

BACKGROUND: Efficacious medications to treat opioid use disorders (OUDs) have been slow to diffuse into practice, and insurance coverage limits may be one important barrier. OBJECTIVES: To compare coverage for medications used to treat OUDs and opioids commonly prescribed for pain management in plans offered on the 2017 Health Insurance Marketplace exchanges. RESEARCH DESIGN: We identified a sample of 100 plans offered in urban and in rural counties on the 2017 Marketplaces, weighting by population. We accessed publicly available plan coverage information on healthcare.gov for states with a federally facilitated exchange, the state exchange website for state-based exchanges, and insurer websites. RESULTS: About 14% of plans do not cover any formulations of buprenorphine/naloxone. Plans were more likely to require prior authorization for any of the covered office-based buprenorphine or naltrexone formulations preferred for maintenance OUD treatment (ie, buprenorphine/naloxone, buprenorphine implants, injectable long-acting naltrexone) than of short-acting opioid pain medications (63.6% vs. 19.4%; P<0.0001). Only 10.6% of plans cover implantable buprenorphine, 26.1% cover injectable naltrexone, and 73.4% cover at least 1 abuse-deterrent opioid pain medication. CONCLUSIONS: Many Marketplace plans either do not cover or require prior authorization for coverage of OUD medications, and these restrictions are often more common for OUD medications than for short-acting opioid pain medications. Regulators tasked with enforcement of the Mental Health Parity and Addiction Equity Act, which requires that standards for formulary design for mental health and substance use disorder drugs be comparable to those for other medications, should focus attention on formulary coverage of OUD medications

(+)-Naloxone · Addiction · Buprenorphine · Environmental health · Health care · Hydromorphone · Naltrexone · Opioid · Opioid use disorder · Population · Prior authorization · Psychiatry · HIV, Drug Use, Sexual Risk · Medicine · Opioid Use Disorder Treatment · Pharmacology · Substance Abuse Treatment and Outcomes