期刊
MEDICAL CARE
卷 60, 期 3, 页码 256-263出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MLR.0000000000001689
关键词
opioid use disorder; medication treatment; insurance; initiation; retention
类别
资金
- Robert Wood Johnson Foundation [76358]
- National Institute on Drug Abuse [R01DA046527, P30DA040500]
This study aims to investigate the association between individuals with opioid use disorder and the cost-sharing for medication, and the results show that only the medical services deductible is associated with MOUD initiation.
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 retained in MOUD at 6 months. A high ($1000+) medical deductible was associated with a lower odds of initiation compared with no deductible (odds ratio: 0.85, 95% confidence interval: 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. Conclusions: 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.
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