NJ Medicaid reforms tied to increased use of opioid addiction treatment
Reforms to New Jersey’s Medicaid program successfully spurred ongoing increases in buprenorphine prescriptions for the treatment of opioid addiction, according to a Rutgers analysis.
Although medications such as buprenorphine effectively combat opioid addiction, less than 30 percent of potential users receive them nationwide. New Jersey sought to increase prescription numbers with three Medicaid reforms that took effect in 2019. The reforms:
- Removed prior authorization requirements for buprenorphine prescriptions
- Increased reimbursement rates for in-office opioid addiction treatment
- Established regional centers of excellence for addiction treatment
Medicaid records showed steady increases in buprenorphine prescriptions before 2019, but the rate of growth increased by 36 percent after the reforms took effect, and this increased rate of growth persisted until the end of the study period in December 2020.
A similar trend affected caregiver behavior. The percentage of caregivers prescribing buprenorphine had been rising before the reforms took effect, but it increased faster after their implementation.
New Jersey also experienced faster growth in buprenorphine prescriptions to Medicaid patients than did other states, the analysis reported, a strong indication that the boosts stemmed from the state’s reforms rather than some unrelated nationwide trend.
The only disappointment came from the study’s measurement of long-term usage. The percentage of buprenorphine prescriptions that remained active for more than 180 days didn’t rise during the study period.
“Usage remains far below the ideal where virtually everyone battling opioid addiction receives an effective medical treatment like buprenorphine,” said Peter Treitler, research project manager for the Rutgers Institute for Health, Health Care Policy and Aging Research and lead author of the analysis published in JAMA Network Open. “However, our analysis suggests these reforms may get us to that point years before we would have reached it under the previous policies.”
Buprenorphine — a once-daily prescription pill sold in the United States as Suboxone, Zubsolv and Sublocade — works in two ways. First, it binds to the same brain cells as drugs such as opium, heroin, morphine, oxycodone and fentanyl. Once it’s in place, those other drugs struggle to dislodge it, bind to the target cells and produce addictive highs. Second, it stimulates a milder effect that reduces cravings for those other drugs and prevents withdrawal symptoms.
Regulators once placed extra restrictions on buprenorphine prescriptions because they worried its mood-altering effects would create more addicts than it cured. These restrictions, which forced caregivers to justify each new buprenorphine prescription at length and investigated providers who prescribed the drug “too often,” led many to avoid prescribing the drug at all, said Treitler, who added Medicaid’s low reimbursement rates for office-based addiction treatment further reduced buprenorphine availability to poor patients.
Regulators have relaxed many restrictions on buprenorphine because opioid addiction has increased. Recent research has shown buprenorphine to be both safer and more effective than previously thought. The reforms to New Jersey’s Medicaid program further reduced barriers to medication usage among its patients.
“They looked at what obstacles were blocking the usage of a valuable drug in this particularly underserved patient population,” Treitler said. “They removed several of the biggest obstacles. And the results so far suggest they’re getting the desired results.”
Indeed, the positive numbers seen in initiatives such as the one undertaken by New Jersey’s Medicaid program may finally be affecting the most important number of all: overdose deaths. After several decades of speedy increases, overdoses nationwide rose by just 500 in 2022.
The trend was even better in New Jersey. Total overdose deaths fell by 232 from 2021 to 2022, and they were 93 lower in the first three months of 2023 than in the first three months of 2022.
JOURNAL
JAMA Network Open
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Buprenorphine Utilization and Prescribing Among New Jersey Medicaid Beneficiaries After Adoption of Initiatives Designed to Improve Treatment Access
ARTICLE PUBLICATION DATE
COI STATEMENT
Mr Treitler reported receiving grants from the National Institute on Drug Abuse, the National Center for Advancing Translational Sciences, and the Foundation for Opioid Response Efforts during the conduct of the study. Dr Samples reported receiving grants from National Institute on Drug Abuse during the conduct of the study and receiving personal fees from American Society of Addiction Medicine for consulting outside the submitted work. Dr Crystal reported receiving grants from the Agency for Healthcare Research and Quality, the Arnold Foundation, and the Pew Charitable Trusts outside the submitted work. No other disclosures were reported.
Treatment for opioid use disorder rises after Medicare OKs methadone coverage
Evidence suggests change created new treatment rather than displacing use of other medications
Peer-Reviewed PublicationThe use of methadone among Medicare beneficiaries to treat opioid use disorder increased sharply after the program began covering the drug, with evidence suggesting the change created new treatment rather than displacing use of other medications, according to a new RAND Corporation study.
Studying a large group of Medicare Advantage enrollees, the study found that a Medicare coverage expansion to include methadone in 2020 did not appear to reduce the use of buprenorphine, another medication used to treat opioid use disorder.
The study, published in the journal JAMA Network Open, found that much of the rise in methadone use was among Medicare Advantage enrollees who are younger than 65, particularly among those who qualify for both Medicare and Medicaid.
“These new policies represent an important step in increasing access to medication treatment for opioid use disorder for Medicare beneficiaries,” said Erin Taylor, the study’s lead author and a senior policy researcher at RAND, a nonprofit research organization.
The nation’s opioid crisis resulted in more than 80,000 overdose deaths in 2021. Using medication to treat opioid use disorder is an effective form of care for people facing the problem.
Buprenorphine and naltrexone are medications that can be prescribed by physicians and taken at home to treat opioid use disorder. In contrast, the medication methadone typically is only dispensed to patients through federally certified and licensed opioid treatment programs.
In January 2020, Medicare expanded payment for treating opioid use disorder to include methadone for the first time. In addition, rules were adopted in March 2020 in response to the COVID-19 pandemic to facilitate access to medication treatment for opioid use disorder, including take-home methadone.
To examine the effects that the changes had on use of opioid treatment drugs among Medicare recipients, RAND researchers examined encounter data and pharmacy records from a large commercial dataset of nearly 10 million people enrolled in Medicare Advantage health plans.
About half of Medicare recipients are enrolled in Medicare Advantage, which are private health plans that typically provide more benefits to enrollees than Medicare fee-for-service, but may limit services to a smaller set of providers.
Researchers found that the implementation of the Medicare coverage change, as well as policies designed to increase access to opioid use disorder treatment during the pandemic, appeared to be associated with increasing rates of methadone use among Medicare Advantage enrollees in each quarter beginning in January 2020.
The rate of use of buprenorphine also increased among Medicare Advantage enrollees during the study period. As with methadone, rates of use of buprenorphine among Medicare Advantage enrollees was higher among those who were younger than 65.
“We found a relatively steady rate of increase in buprenorphine prescribing, which showed no obvious changes after coverage for methadone began,” Taylor said. “This suggests that there was little substituting of methadone for buprenorphine.”
Researchers were unable to assess whether some of the Medicare Advantage enrollees who received methadone under the new policies previously may have received treatment paid for by alternative means, such as block grant programs.
They say future work should explore reasons for the differential increases in methadone use among Medicare Advantage enrollees by dual eligibility status and by age, as well as whether there have been increases in methadone use among beneficiaries enrolled in traditional fee-for-service Medicare.
Support for the study was provided by the National Institute on Aging.
Other authors of the study are Jonathan H. Cantor and Bradley D. Stein, both of RAND, and Ashley C. Bradford and Kosali Simon, both of Indiana University
RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.
JOURNAL
JAMA Network Open
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Trends in Methadone Dispensing for Opioid Use Disorder After Medicare Payment Policy Changes
ARTICLE PUBLICATION DATE
19-May-2023
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