Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017
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...
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| Veröffentlicht in: | Medical care 2018-06, Vol.56 (6), p.505-509 |
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| creator | Huskamp, Haiden A Riedel, Lauren E Barry, Colleen L Busch, Alisa B |
| description | 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 |
| doi_str_mv | 10.1097/MLR.0000000000000918 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5945298</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2069971939</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5118-c59ce50d23556d68d54cb453336ef2dd0d6a6f2f2f3849489d90afe58c8cce3f3</originalsourceid><addsrcrecordid>eNp9kV9PWyEYxsniMmu3b7AYEm9Xx58DB26WLHU6kzY2S3tNKLzHoqeHCqcav724VqO7GCQvAZ73x0MehL5SckqJrr9PJ39OyduhqfqABlTwekR1pQ7QgBAmRjWp9SE6yvmGEFpzwT6hQ6alVLISA3Q3jveQ7DXg2OAp-OBsH2KX8XxlezxPUOrVJsTg8SIDPgs5Jg8J287vzzNuYsIzGzo8tV0hraHr8d9duoV-01oHeNbaLn_DrDj4jD42ts3wZb8O0eL813z8ezS5urgc_5yMnKBUlaodCOIZF0J6qbyo3LISnHMJDfOeeGllw8rkqirf1V4T24BQTjkHvOFD9GPH3WyXa_CuuEq2NZsU1jY9mmiDeX_ThZW5jvdG6EowrQrgZA9I8W4LuTc3cZu64tkwIrWuqea6qKqdyqWYc4Lm9QVKzHNQpgRl_g2qtB2_dffa9JJMEaid4CG2PaR8224fIJkV2LZf_Z_9BNdSn_o</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2069971939</pqid></control><display><type>article</type><title>Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017</title><source>Jstor Complete Legacy</source><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Huskamp, Haiden A ; Riedel, Lauren E ; Barry, Colleen L ; Busch, Alisa B</creator><creatorcontrib>Huskamp, Haiden A ; Riedel, Lauren E ; Barry, Colleen L ; Busch, Alisa B</creatorcontrib><description>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.</description><identifier>ISSN: 0025-7079</identifier><identifier>EISSN: 1537-1948</identifier><identifier>DOI: 10.1097/MLR.0000000000000918</identifier><identifier>PMID: 29668645</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Abuse ; Addictions ; Buprenorphine ; Buprenorphine, Naloxone Drug Combination - economics ; Buprenorphine, Naloxone Drug Combination - therapeutic use ; Design standards ; Drug abuse ; Drug addiction ; Drug administration ; Drug development ; Formulations ; Health care ; Health Insurance Exchanges - economics ; Health Services Accessibility ; Humans ; Implants ; Insurance ; Insurance Coverage - economics ; Insurance Coverage - statistics & numerical data ; Insurance, Pharmaceutical Services ; Mental disorders ; Mental health ; Naloxone ; Naltrexone ; Narcotics ; Opiate Substitution Treatment - economics ; Opiate Substitution Treatment - statistics & numerical data ; Opioid-Related Disorders - drug therapy ; Opioid-Related Disorders - economics ; Opioids ; Pain ; Pain management ; Regulators ; Research design ; Substance use ; Substance use disorder ; Websites</subject><ispartof>Medical care, 2018-06, Vol.56 (6), p.505-509</ispartof><rights>Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright Lippincott Williams & Wilkins Ovid Technologies Jun 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5118-c59ce50d23556d68d54cb453336ef2dd0d6a6f2f2f3849489d90afe58c8cce3f3</citedby><cites>FETCH-LOGICAL-c5118-c59ce50d23556d68d54cb453336ef2dd0d6a6f2f2f3849489d90afe58c8cce3f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29668645$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huskamp, Haiden A</creatorcontrib><creatorcontrib>Riedel, Lauren E</creatorcontrib><creatorcontrib>Barry, Colleen L</creatorcontrib><creatorcontrib>Busch, Alisa B</creatorcontrib><title>Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017</title><title>Medical care</title><addtitle>Med Care</addtitle><description>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.</description><subject>Abuse</subject><subject>Addictions</subject><subject>Buprenorphine</subject><subject>Buprenorphine, Naloxone Drug Combination - economics</subject><subject>Buprenorphine, Naloxone Drug Combination - therapeutic use</subject><subject>Design standards</subject><subject>Drug abuse</subject><subject>Drug addiction</subject><subject>Drug administration</subject><subject>Drug development</subject><subject>Formulations</subject><subject>Health care</subject><subject>Health Insurance Exchanges - economics</subject><subject>Health Services Accessibility</subject><subject>Humans</subject><subject>Implants</subject><subject>Insurance</subject><subject>Insurance Coverage - economics</subject><subject>Insurance Coverage - statistics & numerical data</subject><subject>Insurance, Pharmaceutical Services</subject><subject>Mental disorders</subject><subject>Mental health</subject><subject>Naloxone</subject><subject>Naltrexone</subject><subject>Narcotics</subject><subject>Opiate Substitution Treatment - economics</subject><subject>Opiate Substitution Treatment - statistics & numerical data</subject><subject>Opioid-Related Disorders - drug therapy</subject><subject>Opioid-Related Disorders - economics</subject><subject>Opioids</subject><subject>Pain</subject><subject>Pain management</subject><subject>Regulators</subject><subject>Research design</subject><subject>Substance use</subject><subject>Substance use disorder</subject><subject>Websites</subject><issn>0025-7079</issn><issn>1537-1948</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kV9PWyEYxsniMmu3b7AYEm9Xx58DB26WLHU6kzY2S3tNKLzHoqeHCqcav724VqO7GCQvAZ73x0MehL5SckqJrr9PJ39OyduhqfqABlTwekR1pQ7QgBAmRjWp9SE6yvmGEFpzwT6hQ6alVLISA3Q3jveQ7DXg2OAp-OBsH2KX8XxlezxPUOrVJsTg8SIDPgs5Jg8J287vzzNuYsIzGzo8tV0hraHr8d9duoV-01oHeNbaLn_DrDj4jD42ts3wZb8O0eL813z8ezS5urgc_5yMnKBUlaodCOIZF0J6qbyo3LISnHMJDfOeeGllw8rkqirf1V4T24BQTjkHvOFD9GPH3WyXa_CuuEq2NZsU1jY9mmiDeX_ThZW5jvdG6EowrQrgZA9I8W4LuTc3cZu64tkwIrWuqea6qKqdyqWYc4Lm9QVKzHNQpgRl_g2qtB2_dffa9JJMEaid4CG2PaR8224fIJkV2LZf_Z_9BNdSn_o</recordid><startdate>201806</startdate><enddate>201806</enddate><creator>Huskamp, Haiden A</creator><creator>Riedel, Lauren E</creator><creator>Barry, Colleen L</creator><creator>Busch, Alisa B</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>5PM</scope></search><sort><creationdate>201806</creationdate><title>Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017</title><author>Huskamp, Haiden A ; Riedel, Lauren E ; Barry, Colleen L ; Busch, Alisa B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5118-c59ce50d23556d68d54cb453336ef2dd0d6a6f2f2f3849489d90afe58c8cce3f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abuse</topic><topic>Addictions</topic><topic>Buprenorphine</topic><topic>Buprenorphine, Naloxone Drug Combination - economics</topic><topic>Buprenorphine, Naloxone Drug Combination - therapeutic use</topic><topic>Design standards</topic><topic>Drug abuse</topic><topic>Drug addiction</topic><topic>Drug administration</topic><topic>Drug development</topic><topic>Formulations</topic><topic>Health care</topic><topic>Health Insurance Exchanges - economics</topic><topic>Health Services Accessibility</topic><topic>Humans</topic><topic>Implants</topic><topic>Insurance</topic><topic>Insurance Coverage - economics</topic><topic>Insurance Coverage - statistics & numerical data</topic><topic>Insurance, Pharmaceutical Services</topic><topic>Mental disorders</topic><topic>Mental health</topic><topic>Naloxone</topic><topic>Naltrexone</topic><topic>Narcotics</topic><topic>Opiate Substitution Treatment - economics</topic><topic>Opiate Substitution Treatment - statistics & numerical data</topic><topic>Opioid-Related Disorders - drug therapy</topic><topic>Opioid-Related Disorders - economics</topic><topic>Opioids</topic><topic>Pain</topic><topic>Pain management</topic><topic>Regulators</topic><topic>Research design</topic><topic>Substance use</topic><topic>Substance use disorder</topic><topic>Websites</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huskamp, Haiden A</creatorcontrib><creatorcontrib>Riedel, Lauren E</creatorcontrib><creatorcontrib>Barry, Colleen L</creatorcontrib><creatorcontrib>Busch, Alisa B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Medical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huskamp, Haiden A</au><au>Riedel, Lauren E</au><au>Barry, Colleen L</au><au>Busch, Alisa B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017</atitle><jtitle>Medical care</jtitle><addtitle>Med Care</addtitle><date>2018-06</date><risdate>2018</risdate><volume>56</volume><issue>6</issue><spage>505</spage><epage>509</epage><pages>505-509</pages><issn>0025-7079</issn><eissn>1537-1948</eissn><abstract>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.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>29668645</pmid><doi>10.1097/MLR.0000000000000918</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Medical care, 2018-06, Vol.56 (6), p.505-509 |
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| language | eng |
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| source | Jstor Complete Legacy; MEDLINE; Journals@Ovid Complete |
| subjects | Abuse Addictions Buprenorphine Buprenorphine, Naloxone Drug Combination - economics Buprenorphine, Naloxone Drug Combination - therapeutic use Design standards Drug abuse Drug addiction Drug administration Drug development Formulations Health care Health Insurance Exchanges - economics Health Services Accessibility Humans Implants Insurance Insurance Coverage - economics Insurance Coverage - statistics & numerical data Insurance, Pharmaceutical Services Mental disorders Mental health Naloxone Naltrexone Narcotics Opiate Substitution Treatment - economics Opiate Substitution Treatment - statistics & numerical data Opioid-Related Disorders - drug therapy Opioid-Related Disorders - economics Opioids Pain Pain management Regulators Research design Substance use Substance use disorder Websites |
| title | Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017 |
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