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J Subst Abuse Treat. 2016 Jul;66:23-9. doi: 10.1016/j.jsat.2016.03.001. Epub 2016 Mar 14.

Access to Addiction Pharmacotherapy in Private Health Plans.

Author information

  • 1Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA.. Electronic address: reif@brandeis.edu.
  • 2Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA.. Electronic address: horgan@brandeis.edu.
  • 3Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA.. Electronic address: hodgkin@brandeis.edu.
  • 4Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA.; Department of Health Management and Policy, University of New Hampshire, 4 Library Way, Durham, NH 03824, USA. Electronic address: ann-marie.matteucci@unh.edu.
  • 5Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA.. Electronic address: tcreedon@brandeis.edu.
  • 6Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA.. Electronic address: mstewart@brandeis.edu.

Abstract

BACKGROUND:

An increasing number of medications are available to treat addictions. To understand access to addiction medications, it is essential to consider the role of private health plans. To contain medication expenditures, most U.S. health plans use cost-sharing and administrative controls, which may impact physicians' prescribing and patients' use of addiction medications. This study identified health plan approaches to manage access to and utilization of addiction medications (oral and injectable naltrexone, acamprosate, and buprenorphine).

METHODS:

Data are from a nationally representative survey of private health plans in 2010 (n=385 plans, 935 products; response rate 89%), compared to the same survey in 2003. The study assessed formulary inclusion, prior authorization, step therapy, overall restrictiveness, and if and how health plans encourage pharmacotherapy.

RESULTS:

Formulary exclusions were rare in 2010, with acamprosate excluded most often, by only 9% of products. Injectable naltrexone was covered by 96% of products. Prior authorization was common for injectable naltrexone (85%) and rare for acamprosate (3%). Step therapy policies were used only for injectable naltrexone (41%) and acamprosate (20%). Several medications were often on the most expensive tier. Changes since 2003 include fewer exclusions, yet increased use of other management approaches. Most health plans encourage use of addiction pharmacotherapy, and use a variety of methods to do so.

CONCLUSIONS:

Management of addiction medications has increased over time but it is not ubiquitous. However, health plans now also include all medications on formularies and encourage providers to use them, indicating that they value addiction pharmacotherapy as an evidence-based practice.

KEYWORDS:

Access; Health plans; Insurance; Medication-assisted treatment; Pharmacotherapy; Substance use disorders

PMID:
27211993
PMCID:
PMC4879589
[Available on 2017-07-01]
DOI:
10.1016/j.jsat.2016.03.001
[PubMed - in process]
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