from 2003-2014 Results from a National Survey Sharon Reif, Ph.D. - - PowerPoint PPT Presentation

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from 2003-2014 Results from a National Survey Sharon Reif, Ph.D. - - PowerPoint PPT Presentation

Aug 15, 2023 361 likes •564 views

Institute for Behavioral Health SCHNEIDER INSTITUTES FOR HEALTH POLICY Commercial Health Plan Coverage of Selected Treatment for Opioid Use Disorders from 2003-2014 Results from a National Survey Sharon Reif, Ph.D. Timothy B. Creedon, M.A.

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Institute for Behavioral Health

SCHNEIDER INSTITUTES FOR HEALTH POLICY

Institute for Behavioral Health

SCHNEIDER INSTITUTES FOR HEALTH POLICY

Commercial Health Plan Coverage of Selected Treatment for Opioid Use Disorders from 2003-2014

Results from a National Survey

Sharon Reif, Ph.D. Timothy B. Creedon, M.A. Maureen T. Stewart, Ph.D. Constance M. Horgan, Sc.D. Deborah Garnick, Sc.D.

AcademyHealth Annual Research Meeting – June 2017 Supported by NIDA R01 DA029316, NIAAA R01 AA01086 and by the Brandeis-Harvard NIDA Center to Improve System Performance of Substance Use Disorder Treatment (P30 DA035772)

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Research questions

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  • How has private insurance coverage of selected treatments for
  • pioid use disorders (OUDs) changed over time?
  • How have private health plans approached prior authorization

and continuing review?

  • Do health plans encourage use of pharmacotherapy for OUDs

and if so, how?

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Study overview

  • Telephone survey of nationally representative sample
  • f private health plans alcohol, drug, mental health

services in 2003, 2010, 2014

  • Response rates

– 2003: 83% (N = 368 health plans, 808 products) – 2010: 89% (N = 351 health plans, 935 products) – 2014: 80% (N = 274 health plans, 705 products)

  • Survey administered by Mathematica Policy Research

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Research design

  • Sample frame of market-specific health plans
  • Panel design with replacement
  • Typically 2 respondents per health plan

– Administrative component (Executive Director) – Clinical component (Medical Director)

  • Top 3 commercial products per health plan

– Included top three non-marketplace commercial products (i.e., HMO, PPO, POS, CDP)

  • Weighted to be nationally representative and to

account for complex survey design

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Research domains

  • Benefit design
  • Provider networks
  • Provider payment
  • Primary care integration
  • Entry into specialty alcohol, drug, and mental health

treatment

  • HIV and disease management
  • Prescription drugs (2003, 2010)

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  • Methadone

– Only in licensed Opioid Treatment Programs (OTPs) – Highly regulated – Considered a “service” in insurance benefit

  • Buprenorphine

– “Office-based opioid treatment” (OBOT) – Also in OTPs – 60% offered buprenorphine in 2014 – Restricted to “waived” prescribers, patient caps – A medication covered under pharmacy benefit

  • Injectable Naltrexone

– Sometimes a service, sometimes a medication in insurance benefit

  • Counseling – not included in this paper

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Types of treatment for OUDs

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  • Opioid Treatment Programs

– 2003, 2010, 2014

  • Buprenorphine Pharmacy

– 2003, 2010

  • Opioid Pharmacotherapy

– 2010 – For “encourage” questions

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For this paper…

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  • Coverage
  • Time limits
  • Prior authorization
  • Continuing review
  • Encourage providers

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Selected health plan approaches

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64.5 70.0 69.0 100.0 97.0

  • 20.0

40.0 60.0 80.0 100.0 Percent of Health Plan Products

2003 2010 2014

*Not asked in 2014

*

Opioid Treatment Programs Buprenorphine Pharmacy

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Health plan coverage, by year

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Change in coverage, 2003 to 2010

  • 28.9
  • 32.8

31.0 35.6 69.0 0% 20% 40% 60% 80% 100%

2003 2010 Percent of Products Neither Opioid Treatment Program Only Buprenorphine Pharmacy Only Both

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None 93% 3 months 1% 6 months 1% Other 1% "Std Medical Criteria" 4%

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Methadone time limits, 2010

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Prior authorization required, if covered, by year

79.1 7.9 74.3 38.1 36.5 0.0 20.0 40.0 60.0 80.0 100.0 Percent of Health Plan Products

2003 2010 2014

*Not asked in 2014

*

Opioid Treatment Programs Buprenorphine Pharmacy

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Prior authorization for alcohol and opioid pharmacotherapy, if covered

38% 85% 33% 1% 0% 7% 2% 0%

Buprenorphine (Suboxone) Injectable Naltrexone (Vivitrol) Naltrexone (Revia) Naltrexone (generic) Acamprosate (Campral)

% of products

2003 2010

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Continuing review required, if covered, by year

83.7 73.2 43.5 0.0 20.0 40.0 60.0 80.0 100.0 Percent of Health Plan Products

2003 2010 2014

*Not asked

*

Opioid Treatment Programs Buprenorphine Pharmacy

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Did health plans encourage use of addiction pharmacotherapy, 2010

86% 79% 86% 52%

Opiate dependence - specialty care Opiate dependence - primary care Alcohol dependence - specialty care Alcohol dependence - primary care

% of products

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Ways pharmacotherapy for OUDs is encouraged, by setting, 2010

99% 57% 32% 3% 36% 98% 71% 54% 22% 0%

Provision of guidelines Feedback to providers Training Recognition programs Financial incentives

% of products

Primary Care Specialty

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  • Treatment for OUDs covered by nearly all

products in each year

– Proportion of OTP and buprenorphine coverage varied

  • Rarely methadone time limits in 2010
  • Prior authorization has decreased over time

for OTPs, but increased for buprenorphine

  • Health plans actively encouraged

pharmacotherapy in several ways in 2010

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Summary

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  • Health plan coverage is common, but other

literature notes that treatment rates remain very low

  • Likely other barriers

– Cost, geographical access, availability of waivered prescribers and OTPs

  • Improved health plan coverage for OUD

treatment is necessary, but not sufficient

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Implications

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Tha hank nk you

  • u,

, ques uestions? tions?

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Sharon Reif, PhD; Senior Scientist, Institute for Behavioral Health, The Heller School, Brandeis University reif@brandeis.edu