医疗补助限制对成瘾治疗计划中丁丙诺啡供应的影响。
Impact of Medicaid Restrictions on Availability of Buprenorphine in Addiction Treatment Programs.
机构信息
Christina M. Andrews and Melissa A. Westlake are with the College of Social Work, University of South Carolina, Columbia. Amanda J. Abraham is with the School of Public and International Affairs, University of Georgia, Athens. Colleen M. Grogan and Harold A. Pollack are with the School of Social Service Administration, University of Chicago, Chicago, IL. Peter D. Friedmann is with Baystate Medical Center, Springfield, MA, and the University of Massachusetts, Baystate Campus, Springfield.
出版信息
Am J Public Health. 2019 Mar;109(3):434-436. doi: 10.2105/AJPH.2018.304856. Epub 2019 Jan 24.
OBJECTIVES
To examine how utilization restrictions on state Medicaid benefits for buprenorphine are related to addiction treatment programs' decision to offer the drug.
METHODS
We used data from 2 waves of the National Drug Abuse Treatment System Survey conducted in 2014 and 2017 in the United States to assess the relationship of utilization restrictions to buprenorphine availability.
RESULTS
The proportion of programs offering buprenorphine was 43.2% in states that did not impose any utilization restrictions, 25.5% in states that imposed only annual limits, 17.3% in states that imposed only prior authorization, and 12.8% in states that imposed both. Programs in states requiring prior authorization from Medicaid had substantially lower odds of offering buprenorphine (odds ratio = 0.50; 95% confidence interval = 0.29, 0.87).
CONCLUSIONS
Medicaid prior authorization was linked to lower odds of buprenorphine provision among addiction treatment programs. Public Health Implications. State Medicaid prior authorization requirements are linked to reduced odds of buprenorphine provision among addiction treatment programs and may discourage prescribing.
目的
研究州医疗补助计划中丁丙诺啡使用限制与成瘾治疗计划提供该药物的决策之间的关系。
方法
我们使用了美国 2014 年和 2017 年进行的国家药物滥用治疗系统调查的 2 个波次的数据，评估了使用限制与丁丙诺啡可获得性之间的关系。
结果
在没有实施任何使用限制的州，提供丁丙诺啡的项目比例为 43.2%；在仅实施年度限额的州，这一比例为 25.5%；在仅实施事先授权的州，这一比例为 17.3%；在同时实施这两项限制的州，这一比例为 12.8%。需要从医疗补助计划获得事先授权的州的项目提供丁丙诺啡的可能性要低得多（优势比 = 0.50；95%置信区间 = 0.29，0.87）。
结论
医疗补助计划的事先授权与成瘾治疗项目提供丁丙诺啡的可能性降低有关。公共卫生意义。州医疗补助计划的事先授权要求与成瘾治疗计划中丁丙诺啡供应的可能性降低有关，并可能阻碍处方。
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