Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design

Abstract

Background: The association between cost-sharing and receipt of medication for opioid use disorder (MOUD) is unknown.Methods: We constructed a cohort of 10,513 commercially insured individuals with a new diagnosis of opioid use disorder and information on insurance cost-sharing in a large national deidentified claims database. We examined 4 cost-sharing measures: (1) pharmacy deductible; (2) medical service deductible; (3) pharmacy medication copay; and (4) medical office copay. We measured MOUD (naltrexone, buprenorphine, or methadone) initiation (within 14 d of diagnosis), engagement (second receipt within 34 d of first), and 6-month retention (continuous receipt without 14-d gap). We used multivariable logistic regression to assess the association between cost-sharing and MOUD initiation, engagement, and retention. We calculated total out-of-pocket costs in the 30 days following MOUD initiation for each type of MOUD.Results: Of 10,513 individuals with incident opioid use disorder, 1202 (11%) initiated MOUD, 742 (7%) engaged, and 253 (2%) were

Novel Application of a Multistate Model to Evaluate the Opioid Use Disorder Care Cascade: A Retrospective Cohort Study

“…Other demographic and clinical characteristics that may influence patients' transition along the OUD care cascade were evaluated in our model at baseline only including: age at index was categorized into patients < 40 years, 40 to 60 years, and > 60 years, biological sex (female versus male), and insurance type according to the first claim (Medicaid versus Commercial or Medicare) (22). Clinical, substance use disorder, and behavioral disorders measured at baseline only were included using ICD-9-CM and ICD-10-CM codes (see Appendix A Tables 6).…”

Extended access to fentanyl vapor self-administration leads to addiction-like behaviors in mice: Blood chemokine/cytokine levels as potential biomarkers

“…Treatment with the α 2 -adrenergic receptor agonists lofexidine and clonidine is restricted as an adjuvant during medically supervised withdrawal [ 6 ]. Adherence and retention to the medication-assisted treatment of OUD faces several barriers, such as poor accessibility, high cost, and stigma [ 6 , 7 ]. Additionally, chronic treatment with buprenorphine and methadone may not improve hyperalgesia [ 8 ], which may contribute to the maintenance of drug taking and relapse.…”

The impact of COVID-19 and rapid policy exemptions expanding on access to medication for opioid use disorder (MOUD): A nationwide Veterans Health Administration cohort study

“…Even less is known regarding impacts on other front-line treatments, such as methadone, naltrexone, therapy/counseling, and research to date concerns non-Veterans (e.g., Zhang et al, 2022 ; Will et al, 2022 ; Morgan et al, 2022 ; Hoffman et al, 2022 ; Gomes et al, 2022 ; Joudrey et al, 2021 ). Each treatment was likely impacted differently during the pandemic, as the MOUD policy exemptions did not relate to naltrexone prescriptions and they differentially targeted access to methadone, buprenorphine, and therapy/counseling via telehealth.…”