In 2017, only 25% of individuals received one of three Food and Drug Administration approved medications effected at treating opioid use disorder (OUR) from a substance use disorder treatment facility, despite over half of drug overdose deaths involved an opioid. Utilization restrictions may be a significant coverage barrier to accessing these medications as treatment.
This project will determine the association between utilization restrictions when applied to methadone and buprenorphine formulations and a) opioid treatment program DATA-waivered prescribers geographic distribution and b) access to methadone and buprenorphine treatment for opioid dependence.
This project will also answer the following research question: do utilization restrictions primarily affect access to buprenorphine and methadone through their direct impact on the number of opioid treatment programs and DATA-waivered prescribers in an area?
Findings
An overwhelming proportion of Medicaid programs covered buprenorphine alone and buprenorphine/naloxone combination forms in the preferred drug list. However, with the exception of Suboxone™, all other buprenorphine formulations were subject to PA by more than two thirds of PDLs. Although all plans (100%) covered at least 1 buprenorphine form, almost 30% of plans did not cover at least 1 buprenorphine form without PA.
Although Medicaid programs largely cover buprenorphine products, many continue to apply PA requirements. In the midst of the opioid epidemic, it is challenging to justify the exclusion of buprenorphine coverage and imposition of burdensome utilization management requirements. As policymakers consider strategies to decrease opioid-related morbidity and mortality, they should consider opportunities to mandate the removal of PA. Researchers can expand upon this project by exploring how to define adequate buprenorphine access.
