Impact of Medicaid Prescription Cap Policies on Treatment Outcomes for Opioid Use Disorder: A National Mixed Methods Study

医疗补助处方上限政策对阿片类药物使用障碍治疗结果的影响：一项国家混合方法研究

• 批准号: 10637024
• 负责人: Patience Moyo Dow
• 金额: $ 77.16万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637024
• 关键词: Address; Adoption; Affect; Arkansas; Attention; Budgets; Buprenorphine; Caring; Characteristics; Chronic; Clinic; Clinical; Cost Control; Data; Diagnosis; Drug Prescriptions; Effectiveness; Elderly; Enrollment; Epidemiologist; Equilibrium; General Population; Goals; HIV; Health; Health Care Costs; Health Policy; Health Services; Hospitalization; Hospitals; Improve Access; Individual; Interview; Knowledge; Low income; Medicaid; Medical; Mental Health; Mental disorders; Methadone; Methods; Morbidity - disease rate; Naltrexone; Names; Opioid; Outcome; Overdose; Overdose reduction; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Policies; Population; Prevalence; Process; Provider; Public Health; Qualitative Methods; Recommendation; Research; Research Personnel; Risk; Source; Subgroup; Tennessee; Texas; Time; Treatment Failure; Treatment outcome; United States National Institutes of Health; Vulnerable Populations; access restrictions; beneficiary; chronic pain; comorbidity; cost; disability; evidence base; experience; health goals; health service use; improved; marginalized population; medically necessary care; medication for opioid use disorder; methadone treatment; mortality; novel; opioid epidemic; opioid mortality; opioid use disorder; overdose death; population health; programs; response; severe mental illness; skills; uptake; young adult

PROJECT SUMMARY More than 2 million people have opioid use disorder (OUD) in the U.S. and opioids accounted for 70% of the nearly 100,000 drug-overdose deaths in 2020. Increasing OUD prevalence and opioid-involved overdose deaths underscore the urgent need for improved access to effective OUD treatments. Methadone, buprenorphine, and naltrexone are effective in treating OUD, yet these medications for OUD (MOUD) are underutilized, particularly among low-income Medicaid beneficiaries who represent a sizable portion of the U.S. population living with OUD. Prescription (Rx) caps represent a cost-containment strategy employed by some state Medicaid programs that limit the number of brand name drugs or total number of prescriptions that may be filled each month. Rx cap policies potentially exacerbate the opioid epidemic by impeding access to MOUD among financially constrained Medicaid beneficiaries, many of whom have comorbid chronic health conditions (e.g., mental illness, chronic pain, HIV), and who are forced to make tradeoffs between which medically necessary medications to fill. Though a few older studies have used Medicaid data to evaluate the impact of Rx caps on the health of the general population, until now, this has not been studied among people with OUD – an NIH priority population. The objective of this application is to examine whether and how Medicaid Rx caps affect the care and health of people with OUD and other chronic health conditions. Our long-term research goal is to develop an evidence base that can be used to revise medication utilization management policies in ways that balance budget priorities with improved patient and population health outcomes. Our central hypothesis is that Rx caps contribute to reduced uptake of and continuity with MOUD treatment, resulting in increased overdoses and mortality. The rationale for this hypothesis is that people with OUD frequently have co-occurring conditions and are likely to require several simultaneous prescriptions to manage their health, placing them at risk for exceeding the caps. Our skilled team of health services researchers, pharmacists, clinicians, and epidemiologists has extensive experience using Medicaid claims data and qualitative methods to study the impact of health policies on marginalized populations. We propose to analyze national Medicaid data to evaluate the impact of Rx cap policies on initiation and continuity of MOUD use among individuals diagnosed with OUD; and determine the impact of Rx cap policies on health services utilization, overdoses, and all-cause mortality among this population. We will then contextualize our quantitative findings via interviews with patients with OUD and providers who practice in states impacted by cap policies to elucidate their experiences with caps and identify best practices for navigating these policies. Completion of this research will help to close critical knowledge gaps by generating novel mixed-method findings on Rx drug coverage for OUD treatment and yield best-practice recommendations for navigating cap policies. As states continue to consider strategies to address the worsening opioid and overdose crises, due attention should be given to Medicaid benefit restrictions that can undermine individual and public health goals.

项目摘要 在美国，超过200万人患有绿氧化物疾病（OUD），而opioids占该障碍的70％ 2020年，近100,000例药物过多的死亡。 强调迫切需要改善获得有效的OUD治疗方法。美沙酮，丁丙诺啡和 纳曲酮可有效治疗OUD，但这些用于OUD（MOUD）的药物未充分利用，尤其是 在低收入医疗补助受益人中，这些受益人代表着居住在OUD的美国人口中相当一部分。 处方（RX）上限代表了某些州医疗补助计划执行的成本控制策略 限制每个月可能会填写的品牌毒品数量或处方总数。 Rx帽 政策可能通过阻碍财务约束的穆德访问穆德的访问来加剧oid的流行 医疗补助受益人，其中许多人患有慢性健康状况（例如，精神疾病，慢性疾病 疼痛，艾滋病毒），他们被迫在医学上需要填充的药物之间做出权衡。 一些较旧的研究使用了医疗补助数据来评估RX帽对一般健康的影响 到目前为止，人口尚未在有Oud的人中研究 - NIH优先人口。这 该应用的目的是检查医疗补助RX帽是否以及如何影响人们的护理和健康 OUD和其他慢性健康状况。我们的长期研究目标是建立一个证据基础 可以用来以平衡预算优先级的方式来修改药物利用管理政策 改善患者和人口健康结果。我们的中心假设是RX盖有助于减少 MOUD治疗的吸收和连续性，导致过量和死亡率增加。理由 这个假设是Oud的人经常有同时发生的条件，并且可能需要几个 同时处方以管理其健康状况，使其有可能超过上限的风险。我们熟练的团队 卫生服务研究人员，药剂师，临床医生和流行病学家拥有丰富的经验 医疗补助索赔数据和定性方法，以研究健康政策对边缘化人群的影响。 我们建议分析国家医疗补助数据，以评估RX CAP政策对启动和 被诊断为OUD的个体中moud使用的连续性；并确定RX CAP策略的影响 关于卫生服务的利用，过量服用和全因死亡率。然后我们会 通过与在各州实践的OUD和提供者的患者进行访谈，将我们的定量发现与我们的定量发现相关。 受CAP政策的影响，以阐明他们在帽子上的经验，并确定导航这些的最佳实践 政策。这项研究的完成将有助于通过产生新型混合方法来缩小关键知识差距 RX药物覆盖范围的调查结果，用于导航帽的最佳实践建议 政策。随着各州继续考虑解决令人担忧的阿片类药物和过量危机的策略， 应注意可能破坏个人和公共健康目标的医疗补助福利限制。