This presentation discusses the impact of prior authorization on Buprenorphine dose, relapse, and cost for opioid addiction treatment for Massachusetts Medicaid members.
Presented at the AcademyHealth Annual Research Meeting 2013

Aweh, Gideon

Barton, Bruce A.

Baxter, Jeffrey D.

Clark, Robin E.

Fisher, Bill

O\u27Connell, Elizabeth

English

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University of Massachusetts Medical School eScholarship@UMMS Commonwealth Medicine Publications Commonwealth Medicine 2013-07-20 The Impact of Prior Authorization on Buprenorphine Dose, Relapse and Cost of Opioid Addiction Treatment Robin E. Clark University of Massachusetts Medical School Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/commed_pubs  Part of the Health Economics Commons, Health Law and Policy Commons, Health Policy Commons, Health Services Administration Commons, Health Services Research Commons, and the Substance Abuse and Addiction Commons Repository Citation Clark RE, Baxter JD, Barton BA, Aweh G, O'Connell E, Fisher B. (2013). The Impact of Prior Authorization on Buprenorphine Dose, Relapse and Cost of Opioid Addiction Treatment. Commonwealth Medicine Publications. https://doi.org/10.13028/kwyc-1452. Retrieved from https://escholarship.umassmed.edu/commed_pubs/81 This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Commonwealth Medicine Publications by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. The Impact of Prior Authorization on Buprenorphine Dose, Relapse and Cost of Opioid Addiction Treatment Evidence from Massachusetts’ Medicaid Program Supported by National Institute of Drug Abuse grant number  5R01DA029741  The UMass Research Team • Robin Clark, PhD • Jeff Baxter, MD • Bruce Barton, PhD • Gideon Aweh, MS • Elizabeth O’Connell, MS • Bill Fisher, PhD This presentation is solely the responsibility of the authors and  does not necessarily represent the views of the Massachusetts EOHHS or of NIDA.  The authors have no conflicts of interest to disclose. Buprenorphine/naloxone  Introduced in 2003 (Suboxone®)  First opioid for addiction treatment that can be dispensed in an outpatient setting and taken without direct observation • Considered safer than methadone • Doses > 24 mg not recommended Why we are interested in Buprenorphine & Medicaid?   Medicaid is a key payer for buprenorphine treatment  Increasing concern about cost and diversion of buprenorphine  Most states restrict access through prior authorization requirements  Buprenorphine treatment in MassHealth has risen steadily  0 5000 10000 15000 20000 25000 30000 35000 40000 45000 2003 2004 2005 2006 2007 2008 2009 2010 MassHealth* Members with a Opioid Use Disorder Who were Treated with Buprenorphine Buprenorphine Other *Massachusetts’ Medicaid program Prior Authorization • Prescribers must get authorization before a prescription is filled • Seeks to reduce cost and/or improve safety • Typically imposed by an insurer • A favorite tool for Medicaid programs   Unanticipated Effects • Does not always reduce costs • May break treatment continuity • May contribute to relapse (Law et al, 2008; Abouzaid et al 2010; Lu et al. 2011;  Morden 2008) MassHealth* Prior Authorization for Suboxone® Daily Dose Authorization Frequency > 32 mg Each prescription > 24 mg & < 32 Every 90 days > 16 mg & < 24  Every 180 days < 16 mg None required •Implemented in January 2008 •High doses required more frequent authorization  * The Massachusetts Medicaid Program Research Questions 1. Did high-dose treatment decrease? 2. Did prior authorization affect medication costs and total costs? 3. Did prior authorization affect relapse rates?  Methods • Medicaid claims January 2007 through December of 2008 • Additional data on other publically funded detoxification treatment • Limited to those who used Suboxone® • Three treatment groups: Low dose < 16 mg/day, Medium 16-24 mg, High >24mg Time series • Population level analysis - analyzed claims for all patients using month as the unit of observation • Individual level multivariable analysis - analyzed claims for continuously enrolled patients as the unit of observation (n =2,049) • Generalized estimating equations for both Suboxone users in 2007 Low   n = 908 Medium  n = 699 High  n = 442 Total  n= 2,049 Age 32.9  (9.9) 33.1  (9.4) 34.2  (9.7) 33.2  (9.7) % Women 43.1% 37.0% 33.3% 38.9% MH conditions 1.4  (1.5)  1.3  (1.4) 1.2  (1.2) 1.3  (1.4) Physical conditions 0.7  (1.0) 0.6  (0.9) 0.8  (1.0) 0.7  (1.0) Suboxone® $/month $164  ($96) $284  ($128) $362  ($179) $248  (151) Total $/month $1,372 ($1,640)  $1,110 ($1,025)  $1,102 ($1,185)  $1,224 ($1,367)  (Standard deviation) Suboxone® Doses Before and After Prior Authorization Cost impact • Suboxone® expenditures decreased in the high dose group • Increased in other groups • Net 2008 Suboxone® savings from $131,347 to $492,641  • No savings in overall healthcare costs   Temporary Increase in Relapses Limitations • Measures limited to administrative data • Cannot rule out secular (time) effects  Summary • The PA effectively lowered high doses • Modest decrease in Suboxone® cost • No impact on total cost • Temporary increase in relapses for medium & high dose groups • Long-term impact of dose limits needs further study Why should we care? • At least 6 states now place lifetime limits on buprenorphine treatment • Limiting access to medication-assisted treatment can result in more relapses, deaths and higher costs • Dose related PAs may be a relatively safe way to manage “over prescribing” 

The Impact of Prior Authorization on Buprenorphine Dose, Relapse and Cost of Opioid Addiction Treatment

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The Impact of Prior Authorization on Buprenorphine Dose, Relapse and Cost of Opioid Addiction Treatment

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