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J Addict Med. 2018 Mar/Apr;12(2):85-91. doi: 10.1097/ADM.0000000000000369.

Payer Policy Behavior Towards Opioid Pharmacotherapy Treatment in Ohio.

Author information

1
Ohio Department of Mental Health and Addiction Services (OhioMHAS), Columbus, OH (TM, SS); University of Wisconsin-Madison, Center for Health Enhancement System Studies (CHESS), Madison, WI (CS); University of Wisconsin-Madison School of Education, Madison, WI (J-SK); UW-Center for Tobacco Research and Intervention, Madison, WI (MZ); Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI (AQ); University of Wisconsin-Madison, Institute for Clinical and Translational Research, Madison, WI (NJ); Oregon Health & Science University, Portland, OR (DM).

Abstract

OBJECTIVE:

Few studies examine how payers address the need for improved access to pharmacotherapy for opioid use disorders and the influence of environmental variables on access to opioid agonist and antagonist medications.

METHOD:

The 52 Ohio Addiction Drug Abuse and Mental Health Services (ADAMHS) Boards that disburse funds for treatment services for the uninsured and underinsured were surveyed to assess coverage for opioid agonist and antagonist treatment medications. Analyses examined public health data on regional opioid addiction patterns, characteristics of the local health insurance market, and their associations with coverage for opioid addiction pharmacotherapy.

RESULTS:

Most (70%) of the 44 participating ADAMHS Boards paid for opioid treatment medications. For payment policy, all Boards required behavioral therapy to be provided in conjunction with opioid agonist or opioid antagonist therapy, and 27% of the Boards limited length of a buprenorphine therapy regimen. Higher local opioid treatment admission rates were associated with higher rates of Board funding for opioid treatment pharmacotherapy. Environmental variables (eg, overdose fatality rates or the behaviors of private insurance payers) were not associated with ADAMHS support for opioid agonist or antagonist medication.

CONCLUSIONS:

The analysis highlights the policy preferences of these payers. Follow-up studies should examine the payer decision-making processes, preferences, and attitudes that affect support for pharmacotherapy for opioid dependence.

PMID:
29176511
PMCID:
PMC5847436
DOI:
10.1097/ADM.0000000000000369
[Indexed for MEDLINE]
Free PMC Article

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