Variation in initiation, engagement, and retention on medications for opioid use disorder based on health insurance plan design

Details

• Alternative Title:
  Med Care
• Personal Author:
  Morgan, Jake R. ; Quinn, Emily K. ; Chaisson, Christine E. ; Ciemins, Elizabeth ; Stempniewicz, Nikita ; White, Laura F. ; Linas, Benjamin P. ; Walley, Alexander Y. ; LaRochelle, Marc R.
• Description:
  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 (OUD) and information on insurance cost-sharing in a large national de-identified claims database. We examined four cost-sharing measures: 1) pharmacy deductible; 2) medical service deductible; 3) pharmacy medication co-pay; and 4) medical office co-pay. We measured MOUD (naltrexone, buprenorphine, or methadone) initiation (within 14 days of diagnosis), engagement (second receipt within 34 days of first), and 6-month retention (continuous receipt without 14-day 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 OUD, 1,202 (11%) initiated MOUD, 742 (7%) engaged, and 253 (2%) were retained in MOUD at six months. A high ($1,000+) medical deductible was associated with a lower odds of initiation compared to no deductible (odds ratio: 0.85, 95% CI: 0.74-0.98). We found no significant associations between other cost-sharing measures for initiation, engagement, or retention. Median initial 30-day out-of-pocket costs ranged from $100 for methadone to $710 for extended-release naltrexone.
  
  Conclusion:
  
  Among insurance plan cost-sharing measures, only medical services deductible showed an association with decreased MOUD initiation. Policy and benefit design should consider ways to reduce cost barriers to initiation and retention in MOUD.
  
  
• Subjects:
  Article Child Female Gender Identity Gender Role Humans Initiation Insurance Male Medication Treatment Nigeria Opioid Use Disorder Retention Sex Offenses Sexual Behavior

  More +
• Source:
  Med Care. 60(3):256-263
• Pubmed ID:
  35026792
• Pubmed Central ID:
  PMC8852217
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  60
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:98fa54a282f4bbea4cebec93eca4acd3e7167fe0b4d13c52f8cb39a894fffc19
• Download URL:
  https://stacks.cdc.gov/view/cdc/114590/cdc_114590_DS1.pdf
• File Type:
  [PDF - 175.30 KB ]