RAND Corporation, Santa Monica, California.
The Paul H. O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington.
JAMA Netw Open. 2023 May 1;6(5):e2314328. doi: 10.1001/jamanetworkopen.2023.14328.
A significant proportion of Medicare beneficiaries have a diagnosed opioid use disorder (OUD). Methadone and buprenorphine are both effective medications for the treatment of OUD (MOUDs); however, Medicare did not cover methadone until 2020.
To examine trends in methadone and buprenorphine dispensing among Medicare Advantage (MA) enrollees after 2 policy changes in 2020 related to methadone access.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis of temporal trends in methadone and buprenorphine treatment dispensing assessed MA beneficiary claims from January 1, 2019, through March 31, 2022, captured by Optum's Clinformatics Data Mart. Of 9 870 791 MA enrollees included in the database, 39 252 had at least 1 claim for methadone, buprenorphine, or both during the study period. All available MA enrollees were included. Subanalyses by age and dual eligibility for Medicare and Medicaid status were conducted.
Study exposures were (1) the Centers for Medicare & Medicaid Services (CMS) Medicare bundled payment reimbursement policy for OUD treatment and (2) the Substance Abuse and Mental Health Administration and CMS Medicare policies designed to facilitate access to treatment for OUD, specifically during the COVID-19 pandemic.
Study outcomes were trends in methadone and buprenorphine dispensing by beneficiary characteristics. National methadone and buprenorphine dispensing rates were calculated as claims-based dispensing rates per 1000 MA enrollees.
Among the 39 252 MA enrollees with at least 1 MOUD dispensing claim (mean age, 58.6 [95% CI, 58.57-58.62] years; 45.9% female), 195 196 methadone claims and 540 564 buprenorphine pharmacy claims were identified, for a total of 735 760 dispensing claims. The methadone dispensing rate for MA enrollees was 0 in 2019 because the policy did not allow any payment until 2020. Claims rates per 1000 MA enrollees were low initially, increasing from 0.98 in the first quarter of 2020 to 4.71 in the first quarter of 2022. Increases were primarily associated with dually eligible beneficiaries and beneficiaries younger than 65 years. National buprenorphine dispensing rates were 4.64 per 1000 enrollees in quarter 1 of 2019, increasing to 7.45 per 1000 enrollees in quarter 1 of 2022.
This cross-sectional study found that methadone dispensing increased among Medicare beneficiaries after the policy changes. Rates of buprenorphine dispensing did not provide evidence that beneficiaries substituted buprenorphine for methadone. The 2 new CMS policies represent an important first step in increasing access to MOUD treatment for Medicare beneficiaries.
相当一部分医疗保险受益人的阿片类药物使用障碍（OUD）得到了诊断。美沙酮和丁丙诺啡都是治疗 OUD（MOUD）的有效药物；然而，医疗保险直到 2020 年才开始覆盖美沙酮。
研究 2020 年与美沙酮获取相关的两项政策变化后，医疗保险优势（MA）参保者中接受美沙酮和丁丙诺啡治疗的人数趋势。
设计、地点和参与者：这项关于美沙酮和丁丙诺啡治疗分配的时间趋势的横断面分析评估了从 2019 年 1 月 1 日至 2022 年 3 月 31 日期间，通过 Optum 的 Clinformatics Data Mart 捕获的医疗保险优势受益人的索赔数据。在数据库中纳入的 9870791 名 MA 参保者中，有 39252 名在研究期间至少有 1 次美沙酮、丁丙诺啡或两者的索赔。纳入了所有可用的 MA 参保者。进行了按年龄和同时符合医疗保险和医疗补助资格的双重资格进行的亚组分析。
研究暴露因素为（1）医疗保险和医疗补助服务中心（CMS）针对 OUD 治疗的捆绑支付报销政策和（2）旨在为 OUD 治疗提供便利的药物滥用和心理健康管理局和 CMS 医疗保险政策，特别是在 COVID-19 大流行期间。
研究结果是按受益人的特征划分的美沙酮和丁丙诺啡分配趋势。国家美沙酮和丁丙诺啡分配率计算为每 1000 名 MA 参保者的索赔分配率。
在至少有 1 次 MOUD 分配索赔的 39252 名 MA 参保者中（平均年龄，58.6[95%CI，58.57-58.62]岁；45.9%为女性），确定了 195196 次美沙酮和 540564 次丁丙诺啡药房索赔，共分配了 735760 次。2019 年 MA 参保者的美沙酮分配率为 0，因为该政策直到 2020 年才允许任何支付。按每 1000 名 MA 参保者计算的索赔率最初较低，从 2020 年第一季度的 0.98 增加到 2022 年第一季度的 4.71。增加主要与双重合格的受益人和 65 岁以下的受益人类别相关。2019 年第一季度，国家丁丙诺啡分配率为每 1000 名参保者 4.64，到 2022 年第一季度增加到每 1000 名参保者 7.45。
这项横断面研究发现，在政策变化后，医疗保险受益人的美沙酮分配量增加。丁丙诺啡分配率没有提供证据表明受益人用丁丙诺啡替代美沙酮。这两项新的 CMS 政策代表了增加医疗保险受益人的 MOUD 治疗机会的重要的第一步。
