Institute for Biomedical Informatics, College of Medicine, University of Kentucky, United States of America; Department of Internal Medicine, College of Medicine, University of Kentucky, United States of America.
Institute for Biomedical Informatics, College of Medicine, University of Kentucky, United States of America; Department of Internal Medicine, College of Medicine, University of Kentucky, United States of America.
J Subst Use Addict Treat. 2024 Sep;164:209391. doi: 10.1016/j.josat.2024.209391. Epub 2024 May 11.
Long-acting injectable buprenorphine (LAI-bup) formulations have advantages over transmucosal buprenorphine (TM-bup), but barriers may limit their utilization. Several policies shifted during the COVID-19 pandemic to promote buprenorphine access. The federal government expanded telemedicine treatment for opioid use disorder and Kentucky (KY) Medicaid lifted prior authorization requirements (PAs) for LAI-bup (i.e., Sublocade®). This retrospective cohort study evaluated changes in LAI-bup access, utilization, and retention before and after these policy changes in KY.
Individual-level TM-bup and LAI-bup dispensing record data from KY's prescription drug monitoring program examined LAI-bup utilization and retention, without a >30-day gap in coverage, for patients starting a new episode of LAI-bup treatment. Two key time periods were examined: pre-policy changes (Apr 1, 2019 - Dec 31, 2019) and post-policy changes (Apr 1, 2020 - Dec 31, 2020). Data on PA requests among Medicaid managed care organizations and availability of LAI-bup Risk Evaluation and Mitigation Strategy (REMS)-certified pharmacies were also obtained. A multivariable Cox proportional hazard regression model analysis compared pre- versus post-policy period treatment discontinuation.
The number of patients initiating LAI-bup increased from 211 to 481 over the two periods. By the end of the post-policy period, 24.3 % of eligible patients were retained on LAI-bup, versus 12.5 % in the pre-policy change period. The adjusted hazard ratio, comparing discontinuation during the post- versus pre-policy change periods, was 0.70 (95 % confidence interval: 0.55-0.89). There were also more REMS-certified pharmacies and providers in the post-policy change period.
LAI-bup access, utilization, and retention increased after several policy changes.
长效丁丙诺啡（LAI-bup）制剂比经黏膜丁丙诺啡（TM-bup）具有优势，但可能存在一些障碍限制了其使用。在 COVID-19 大流行期间，有几项政策发生了变化，以促进丁丙诺啡的获取。联邦政府扩大了治疗阿片类药物使用障碍的远程医疗服务，肯塔基州（KY）医疗补助计划取消了 LAI-bup（即苏布洛克）的事先授权要求（PA）。这项回顾性队列研究评估了 KY 政策变化前后 LAI-bup 的获取、使用和保留情况。
从 KY 处方药物监测项目的个人 TM-bup 和 LAI-bup 配药记录数据中，对于开始新的 LAI-bup 治疗的患者，检查 LAI-bup 的使用和保留情况，无覆盖>30 天的空白期。研究人员检查了两个关键时间段：政策变化前（2019 年 4 月 1 日-2019 年 12 月 31 日）和政策变化后（2020 年 4 月 1 日-2020 年 12 月 31 日）。还获得了关于医疗补助管理式医疗组织中 PA 请求和 LAI-bup 风险评估和缓解策略（REMS）认证药房的可用性的数据。多变量 Cox 比例风险回归模型分析比较了政策前与政策后期间的治疗中断情况。
在两个时期内，开始接受 LAI-bup 治疗的患者人数从 211 人增加到 481 人。在政策后时期结束时，24.3%符合条件的患者继续接受 LAI-bup 治疗，而政策前变化时期为 12.5%。与政策前变化期间相比，比较政策后期间停药的调整后危险比为 0.70（95%置信区间：0.55-0.89）。政策后变化时期也有更多的 REMS 认证药房和提供者。
几项政策变化后，LAI-bup 的获取、使用和保留增加。
