Humana Inc., Louisville, KY.
J Manag Care Spec Pharm. 2021 May;27(5):596-606. doi: 10.18553/jmcp.2021.27.5.596.
More than 30% of Medicare beneficiaries and 40% of patients dually eligible for Medicare and Medicaid use opioids. With an estimated 8%-12% of patients developing an opioid use disorder (OUD) after initiating opioids, opioid misuse is a significant public health challenge, especially among high-risk Medicare populations. Medication-assisted treatment (MAT) is the use of medications for the treatment of OUD and to prevent relapse to opioid use. MAT is the most effective treatment for OUD. There are a variety of barriers to MAT therapy that may delay access to treatment. To study the impact of the removal of prior authorization requirements for MAT medications on MAT utilization, opioid utilization, and clinical outcomes, including emergency department visits, inpatient admission, relapse rates, behavioral health services, and nonopioid pain medication utilization, among opioid-using individuals with Medicare Advantage Prescription Drug (MAPD) coverage. This retrospective, cross-sectional study used administrative medical, pharmacy, and enrollment data to identify chronic opioid users and a subset cohort initiating MAT use in 2017, when prior authorization requirements were in effect, and 2018 after removal of prior authorization requirements. Opioid and MAT utilization and clinical outcomes from emergency department visits were also examined before and after prior authorization requirements. A logistic regression analysis was conducted to examine the impact of the policy change on relapse rates, comparing relapse rates in 2017 and 2018, after controlling for potentially confounding demographic and clinical factors. This policy change was followed by a decrease in opioid utilization, an increase in MAT initiation, and a 4% decline in relapse rates. Patients initiating MAT after removal of prior authorizations had a 19% decrease in likelihood of relapse, and those with an OUD diagnosis were 47% less likely to relapse. The majority of MAT recipients were aged younger than 65 years, had a mental or behavioral health disorder diagnosis, and initially used relatively low doses (< 90 MME) of prescription opioids. There were no statistically significant differences in the use of behavioral health services or the use of nonopioid medications from 2017 to 2018. Utilization management policies should ensure appropriate MAT use, while minimizing impediments to access. Providing patients with evidence-based therapy effective for the treatment of OUD is essential to patient recovery and combating the consequences of the opioid epidemic. Further strides are needed to eliminate additional obstacles to OUD care. No outside funding supported this study. All authors are or were employees of Humana, Inc., at the time of the study and have no other potential conflicts of interest to disclose.
超过 30%的医疗保险受益人和 40%同时符合医疗保险和医疗补助资格的患者使用阿片类药物。估计有 8%-12%的患者在开始使用阿片类药物后会出现阿片类药物使用障碍 (OUD)，因此阿片类药物滥用是一个重大的公共卫生挑战，尤其是在高风险的医疗保险人群中。药物辅助治疗 (MAT) 是使用药物治疗 OUD 并防止阿片类药物使用复发。MAT 是治疗 OUD 最有效的方法。MAT 治疗存在多种障碍，可能会延迟治疗的获得。为了研究取消 MAT 药物事先授权要求对 MAT 利用率、阿片类药物利用率和临床结果的影响，包括急诊就诊、住院入院、复发率、行为健康服务和非阿片类止痛药利用率，研究人员在具有医疗保险优势处方药 (MAPD) 覆盖的阿片类药物使用者中进行了这项回顾性、横断面研究。该研究使用行政医疗、药房和登记数据来确定慢性阿片类药物使用者和 2017 年开始使用 MAT 的亚队列，当时事先授权要求仍然有效，2018 年在取消事先授权要求后。还检查了急诊就诊前和后阿片类药物和 MAT 利用率和临床结果。在控制了潜在的混杂人口统计学和临床因素后，进行逻辑回归分析以检查政策变化对复发率的影响，比较 2017 年和 2018 年的复发率。这项政策变化后，阿片类药物利用率下降，MAT 启动增加，复发率下降 4%。在取消事先授权后开始 MAT 的患者复发的可能性降低了 19%，而 OUD 诊断患者复发的可能性降低了 47%。大多数 MAT 接受者年龄小于 65 岁，有精神或行为健康障碍诊断，最初使用相对较低剂量 (< 90 MME) 的处方阿片类药物。2017 年至 2018 年，行为健康服务的使用或非阿片类药物的使用没有统计学上的显著差异。利用管理政策应确保适当的 MAT 使用，同时尽量减少获得治疗的障碍。为患者提供针对 OUD 的有效循证治疗对于患者康复和应对阿片类药物流行的后果至关重要。还需要进一步努力消除 OUD 护理的其他障碍。这项研究没有外部资金支持。所有作者在研究期间均为 Humana, Inc. 的员工，并且没有其他潜在的利益冲突需要披露。
