Insurance-Related Barriers to Medications for Opioid Use Disorder in Private and Medicaid plans

Project start date and end date: 2022 - 2026

Background:

In 2021, a record 80,000 opioid overdose deaths occurred in the U.S, highlighting the importance of identifying and reducing barriers to accessing medications for opioid use disorder (MOUD). In this proposal, we will provide actionable, policy-relevant information on the effect of cost-sharing for MOUD in privately insured patients and on the effect of removing prior authorization requirements for MOUD in Medicaid patients. Findings will demonstrate whether mitigating cost-sharing and prior authorization requirements for MOUD could slow the record rise in opioid overdose deaths or whether policy efforts to achieve this goal should focus elsewhere.

Objectives:

• Aim 1. To evaluate whether cost-sharing is associated with non-dispensing of MOUD prescriptions and opioid overdose risk in privately insured patients.
• Aim 2. To evaluate the effects of state policies eliminating prior authorization requirements for MOUD on MOUD use and opioid overdose risk in Medicaid patients.

Research Topics & Methods:

• This proposal will rigorously evaluate the effect of cost-sharing for MOUD in privately insured patients and on the effect of removing prior authorization requirements for MOUD in Medicaid patients. Analyses will focus on patients aged 15-64 years, an age group accounting for 96% of U.S. opioid overdose deaths. We will use 2017-2023 data from several national databases, including a pharmacy transaction database capturing 63% of U.S. prescriptions (IQVIA Formulary Impact Analyzer), prescription dispensing data from 92% of U.S. pharmacies (IQVIA Longitudinal Prescription Database), a national commercial claims database from 20 million Americans (Optum Labs Data Warehouse), and 100% Medicaid claims from all states.

Implications:

This proposal is innovative owing to its exploitation of resetting deductibles as a natural experiment, use of data that reports cost-sharing for both dispensed and non-dispensed prescriptions, and evaluation of the effects of employer-mandated enrollment in a higher-deductible plan. This proposal is significant because it will demonstrate whether mitigating cost-sharing and prior authorization requirements for MOUD could slow the record rise in opioid overdose deaths or whether policy efforts to achieve this goal should focus elsewhere.

Funder:

This project is funded by the National Institute on Drug Abuse.

Collaborators:

Thuy Nguyen (MPI); Rena Conti (Co-I, Boston University); Amy Bohnert (Co-I); Pooja Lagisetty (Co-I)