Treating people with opioid use disorder (OUD) with buprenorphine is known to reduce opioid use, drug overdoses, and hospital visits, but the medication is underused. Two reports published yesterday—one appearing in JAMA Internal Medicine and another in JAMA Pediatrics—suggest that out-of-pocket costs for buprenorphine may be partly to blame for keeping the drug out of reach for adults and youth with OUD who have private health insurance.
As described in JAMA Internal Medicine, Ashley A. Leech, Ph.D., M.S., of Vanderbilt University School of Medicine and colleagues used the MarketScan Commercial Claims Database to track patients aged 18 to 64 years who initiated buprenorphine between April 1, 2013, and December 31, 2020. They wanted to understand the association between out-of-pocket costs for patients’ initial buprenorphine prescription (index fill) and buprenorphine discontinuation within one year.
Between 2013 and 2020, 40,035 commercially insured patients (median age, 34 years) began taking buprenorphine for OUD. “Only 22% of patients continuously used buprenorphine during the follow-up period, and 6% switched to naltrexone,” Leech and colleagues reported. They found that the higher the daily out-of-pocket costs for the patients, the higher the risk of medication discontinuation.
“Policies addressing patient-level hurdles within the OUD cascade of care may prevent lasting impact on adverse health outcomes associated with OUD,” Leech and colleagues wrote.
In the JAMA Pediatrics report, Andrew Terranella, M.D., M.P.H., of the CDC’s Division of Overdose Prevention and colleagues described how they studied IQVIA Longitudinal Prescription Data (which tracks the majority of U.S. prescriptions) to determine out-of-pocket costs for buprenorphine dispensed to youth aged 12 to 19 years between 2015 and 2020. Daily out-of-pocket costs were calculated across prescriptions and adjusted to 2020 dollars using the Consumer Price Index, the researchers noted.
“Mean daily [out-of-pocket] costs for buprenorphine declined between 2015 and 2020, with an increasing percentage of prescriptions paid by Medicaid. Nonetheless, mean daily [out-of-pocket] costs were approximately 24 times higher with commercial payers and 119 times higher for self-pay than for Medicaid in 2020,” Terranella and colleagues wrote. “The largest disparities by region, urban or rural status, and age were in the South, rural counties, and among younger adolescents.”
Leech and colleagues concluded, “The Patient Protection and Affordable Care Act’s preventive drug list mandates private insurance plans [to] cover recommended preventive services without patient cost-sharing. Adding OUD medications to this list could alleviate lasting consequences of the opioid crisis.”
For related information, see the Psychiatric Services article “Early Discontinuation of Buprenorphine Therapy for Opioid Use Disorder Among Privately Insured Adults.”
(Image: iStock/dusanpetkovic)
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