Physicians as Mediators of Health Policy: Acceptance of Medicaid in the Context of Buprenorphine Treatment

Knudsen, Hannah K.; Studts, Jamie L.

doi:10.1007/s11414-018-9629-4

Cited by 19 publications

(17 citation statements)

References 63 publications

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“…Our use of physician Medicaid acceptance may have been an imperfect proxy for buprenorphine provider Medicaid acceptance. Approximately half of buprenorphine prescribers in a national survey reported accepting Medicaid for office visits, far below the reported average rates of physician Medicaid acceptance. Future studies should continue examining the role of Medicaid acceptance on OAT access, including policies to increased Medicaid acceptance.…”

Section: Discussionmentioning

confidence: 82%

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The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints

Gertner

Robertson

Jones³

et al. 2020

Health Services Research

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Objective:To determine the effect of Medicaid expansion on the use of opioid agonist treatment for opioid use disorder (OUD) and to examine heterogeneous effects by provider supply and Medicaid acceptance rates. Data Sources: Yearly state-level data on methadone dispensed from opioid treatment programs (OTPs), buprenorphine dispensed from OTPs and pharmacies, number of OTPs and buprenorphine-waivered providers, and percent of OTPs and physicians accepting Medicaid. Study Design: This study used difference-in-differences models to examine the effect of Medicaid expansion on the amount of methadone and buprenorphine dispensed in states between 2006 and 2017. Interaction terms were used to estimate heterogeneous effects. Sensitivity analyses included testing the association of outcomes with Medicaid enrollment and state insurance rates.Principal Findings: The estimated effects of Medicaid expansion on buprenorphine and methadone dispensed were positive but imprecise, meaning we could not rule out negative or null effects of expansion. The estimated associations between state insurance rates and dispensed methadone and buprenorphine were centered near zero, suggesting that improvements in health coverage may not have increased OUD treatment use. The effect of Medicaid expansion was larger in the states with the most waivered providers compared to states with the fewest waivered providers. In the states with the most waivered providers, the average estimated effect of expansion on buprenorphine dispensed was 12 kg/y, enough to treat about 7500 individuals. We did not find evidence that the effect of expansion was consistently modified by OTP concentration, OTP Medicaid acceptance, or physician Medicaid acceptance. Conclusions:Gains in health coverage may not be sufficient to increase OUD treatment, even in the context of high treatment need. Provider capacity likely limited Medicaid expansion's effect on buprenorphine dispensed. Policies to increase buprenorphine providers, such as ending the waiver requirement, may be needed to ensure coverage gains translate to treatment access. K E Y W O R D S buprenorphine, Medicaid expansion, methadone, opioid use disorder 384 | Additional supporting information may be found online in the Supporting Information section. How to cite this article: Gertner AK, Robertson AG, Jones H, Powell BJ, Silberman P, Domino ME. The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints. Health Serv Res. 2020;55:383-392. https://doi.

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Section: Discussionmentioning

confidence: 82%

“…Evidence suggests nearly all states lack enough OTPs and waivered physicians to provide OAT to all individuals in need . This shortage is exacerbated by the fact that only approximately half of buprenorphine prescribers report accepting Medicaid for office visits …”

Section: Introductionmentioning

confidence: 99%

The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints

Gertner

Robertson

Jones³

et al. 2020

Health Services Research

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“…Policies that have been proposed to facilitate retention in methadone treatment in particular include relaxing restrictions on take-home doses, deploying mobile methadone vans, and establishing "medication-only" sites. 90 Our analysis reveals a number of apparent disparities in access to and/or uptake of MAT for (Knudsen and Studts 2019), a review of such rates would be an important subject for policy debate.…”

Section: Discussionmentioning

confidence: 93%

“…The retail price of Suboxone, a popular formulation of buprenorphine, runs from $6 to $24 per day. 17 Even when insurance covers MAT, some providers choose not to accept patients with some types of insurance (often Medicaid) due to inadequate reimbursement rates, and some refuse to accept any form of health insurance (Knudsen and Studts 2019;Flavin et al 2020). Many states, including Rhode Island, offer targeted subsidies for methadone to uninsured residents, although such subsidies are not on par with comprehensive health insurance benefits for substance abuse treatment.…”

Section: B Barriers To Treatmentmentioning

confidence: 99%

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Who Gets Medication-assisted Treatment for Opioid Use Disorder, and Does It Reduce Overdose Risk? Evidence from the Rhode Island All-payer Claims Database

Burke

Sullivan

Carman

et al. 2021

Federal Reserve Bank of Boston Research Department Working Papers

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This paper uses the all-payer claims database (APCD) for Rhode Island to study three questions about the use of medication-assisted treatment (MAT) for opioid use disorder (OUD): (1) Does MAT reduce the risk of opioid overdose; (2) are there systematic differences in the uptake of MAT by observable patient-level characteristics; and (3) how successful were federal policy changes implemented in 2016 that sought to promote increased use of buprenorphine, one of three medication options within MAT? Regarding the first question, we find that MAT as practiced in Rhode Island is associated with a reduced risk of repeated opioid overdose among patients who had an initial nonfatal opioid overdose, consistent with the strong endorsement of MAT by public health officials. Concerning the second, we find that factors such as age, gender, health insurance payer, and the poverty rate in one's residential Zip code are associated with significant differences in the chance of receiving methadone and/or buprenorphine, suggesting that certain groups may face unwarranted disparities in access to MAT. About the third question, we find that a 2016 federal rule change enabled at least some experienced Rhode Island buprenorphine prescribers to reach more patients, and a separate 2016 policy aimed at recruiting new buprenorphine prescribers was also found to be effective. However, the data also suggest that many more patients in the state could be treated with buprenorphine if prescribers took full advantage of their prescribing limits.

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A bifurcated opioid treatment system and widening insidious disparities

Guerrero¹,

Amaro²,

Khachikian³

et al. 2022

Addictive Behaviors

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Physicians as Mediators of Health Policy: Acceptance of Medicaid in the Context of Buprenorphine Treatment

Cited by 19 publications

References 63 publications

The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints

The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints

Who Gets Medication-assisted Treatment for Opioid Use Disorder, and Does It Reduce Overdose Risk? Evidence from the Rhode Island All-payer Claims Database

A bifurcated opioid treatment system and widening insidious disparities

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