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.

项目概要 美国有超过200万人患有阿片类药物使用障碍（OUD），其中阿片类药物占70% 2020 年，近 100,000 人因药物过量死亡。 OUD 患病率增加，阿片类药物过量死亡 强调迫切需要改善获得有效 OUD 治疗的机会。 纳曲酮可有效治疗 OUD，但这些治疗 OUD (MOUD) 的药物尚未得到充分利用，特别是 低收入医疗补助受益人占 OUD 居住美国人口的很大一部分。 处方 (Rx) 上限代表了一些州医疗补助计划采用的成本控制策略， 限制每月可配药的品牌药物数量或处方总数。 政策可能会阻碍经济拮据的人获得 MOUD 服务，从而加剧阿片类药物的流行 医疗补助受益人，其中许多人患有慢性疾病（例如精神疾病、慢性疾病） 疼痛、艾滋病毒），以及被迫在需要补充医疗必需药物之间进行权衡的人。 一些较早的研究使用医疗补助数据来评估处方上限对一般健康的影响 人群，到目前为止，这还没有出现在 OUD 人群（NIH 优先人群）的研究对象中。 此应用程序的目的是检查 Medicaid Rx 上限是否以及如何影响人们的护理和健康 我们的长期研究目标是建立一个证据基础来证明 OUD 和其他慢性健康状况。 可用于修订药物利用管理政策，以平衡预算优先事项与 我们的中心假设是，处方上限有助于减少患者和人群的健康结果。 MOUD 治疗的采用和连续性，导致用药过量和死亡率增加的理由。 这个假设是，患有 OUD 的人经常有同时发生的病症，并且可能需要几种 同时开出处方来管理他们的健康，使他们面临超出上限的风险。 的卫生服务研究人员、药剂师、扩音器和流行病学家拥有丰富的使用经验 医疗补助声称提供数据和定性方法来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，以评估处方上限政策对启动和实施的影响。 诊断为 OUD 的个体中 MOUD 使用的连续性；并确定 Rx 上限政策的影响 然后我们将了解该人群的卫生服务利用、用药过量和全因死亡率。 通过对 OUD 患者和在各州执业的医疗服务提供者的访谈，将我们的定量研究结果结合起来 受上限政策影响，阐明他们在上限方面的经验，并确定应对这些政策的最佳实践 完成这项研究将有助于通过产生新颖的混合方法来缩小关键知识差距。 OUD 治疗的 Rx 药物覆盖范围的调查结果并产生了应对上限的最佳实践建议 随着各国继续考虑解决日益恶化的阿片类药物和过量危机的策略。 应注意可能损害个人和公共卫生目标的医疗补助福利限制。