Watema-Lord Ronald, Xie Feng, Sanyal Chiranjeev
J Am Pharm Assoc (2003). 2025 Jan-Feb;65(1):102299. doi: 10.1016/j.japh.2024.102299. Epub 2024 Dec 2.
The opioid epidemic is a major public health crisis in Canada and elsewhere. The increase in opioid prescriptions is a major contributor to this crisis. Medications for opioid use disorder (OUD) and overdose are effective and lifesaving treatments. Often, patients do not have adequate insurance coverage (or uninsured) for medications for OUD and have to pay out of pocket (OOP). OOP costs (OOPCs) result in financial burdens among patients, limiting their access to medications for OUD, and overdose.
To identify the evidence on (1) the OOPCs of medications for OUD and overdose, and (2) the effect of insurance coverage (or being uninsured) and corresponding OOPCs on medications for OUD initiation, retention, and discontinuation.
This scoping review was conducted in accordance with methodological guidance from the Joanna Briggs Institute. The literature search aimed to identify peer-reviewed publications in English in MEDLINE, Embase, and CINAHL, which were searched from inception to March 22, 2024. Two reviewers independently completed title, abstract, and full-text screening against inclusion criteria. Data extracted were used to describe the body of literature using descriptive and qualitative approaches.
Out of the 2003 search results, a total of ten studies met the inclusion criteria and were included in the review. Uninsured patients have paid higher OOPCs compared to private or publicly insured patients. Among privately insured patients with OUD, greater OOPC may result in poor retention of buprenorphine. The risk of discontinuation was higher with the buprenorphine/naloxone tablet compared with the sublingual buprenorphine/naloxone film. Generic substitution or providing coverage for these medications being dispensed from community pharmacies can potentially minimize the burden of OOPCs and improve access.
The literature highlights beneficiaries of private/commercial health plans experience a substantial burden of OOPCs, creating barriers to treatment initiation, retention, and adherence to medications for OUD.
阿片类药物流行是加拿大及其他地区的重大公共卫生危机。阿片类药物处方量的增加是这场危机的主要促成因素。用于阿片类药物使用障碍（OUD）和过量用药的药物是有效的救命治疗方法。通常，患者没有足够的保险来支付治疗OUD的药物费用（或未参保），不得不自掏腰包。自付费用（OOPCs）给患者带来了经济负担，限制了他们获得治疗OUD和过量用药药物的机会。
确定关于（1）治疗OUD和过量用药药物的OOPCs，以及（2）保险覆盖（或未参保）及相应的OOPCs对启动、持续使用和停用治疗OUD药物的影响的证据。
本范围综述按照乔安娜·布里格斯研究所的方法学指南进行。文献检索旨在识别MEDLINE、Embase和CINAHL数据库中从建库至2024年3月22日期间以英文发表的同行评审出版物。两名评审员根据纳入标准独立完成标题、摘要和全文筛选。提取的数据用于采用描述性和定性方法描述文献主体。
在2003条检索结果中，共有10项研究符合纳入标准并被纳入综述。与有私人保险或公共保险的患者相比未参保患者支付的OOPCs更高。在患有OUD的私人保险患者中，更高的OOPC可能导致丁丙诺啡的持续使用率较低。与舌下含服丁丙诺啡/纳洛酮薄膜相比，丁丙诺啡/纳洛酮片剂停药风险更高。通用替代或为从社区药房配取的这些药物提供保险覆盖可能会潜在地减轻OOPCs负担并改善可及性。
文献强调了私人/商业健康保险计划的受益人群面临着巨大的OOPCs负担，这对治疗OUD药物的启动、持续使用和依从性造成了障碍。
