Medicaid managed care restrictions on medications for the treatment of opioid use disorder.

Objective: To examine whether Medicaid managed care plan (MCP) utilization management policies for buprenorphine-naloxone and injectable naltrexone are related to key state Medicaid program policy decisions.

Data Sources And Study Setting: We abstracted data on state Medicaid regulatory and policy information from publicly available sources and publicly available insurance benefit documentation from all 241 Medicaid MCPs operating in 2021.

Study Design: In this cross-sectional study, we used bivariate and multivariate analyses to examine whether Medicaid MCP prior authorization and quantity limits on receipt of buprenorphine and injectable naltrexone were associated with key state Medicaid choices to leverage federal funds to expand coverage and eligibility (Medicaid expansion, 1115 waivers) and to regulate Medicaid MCPs (uniform preferred drug lists, medical loss ratio remittance).

Expanding access to medication treatment for opioid use disorders: Findings from the Washington State hub and spoke effort.

Background: Opioid use disorder (OUD) is a leading cause of preventable death and injury nationwide. Efforts to increase the use of medication for opioid use disorder (MOUD) are needed. In 2017, Washington State implemented a Hub and Spoke (HS) model of care with the primary goal of expanding access to MOUD.

State alignment with federal regulations in 2022 to relax buprenorphine 30-patient waiver requirements.

Background: In 2021, the Department of Health and Human Services released guidelines allowing waiver-eligible providers seeking to treat up to 30 patients to be exempt from waiver training (WT) and the counseling and other ancillary services (CAS) attestation. This study evaluates if states and the District of Columbia had more restrictive policies preventing adoption of the 2021 federal guidelines.

Methods: First, the Westlaw database was searched for buprenorphine regulations.

Quality of Opioid Use Disorder Treatment for Persons With and Without Disabling Conditions.

Importance: Adverse outcomes associated with opioid use disorder (OUD) are disproportionately high among people with disabilities (PWD) compared with those without disability. A gap remains in understanding the quality of OUD treatment for people with physical, sensory, cognitive, and developmental disabilities, specifically regarding medications for OUD (MOUD), a foundation of treatment.

Objective: To examine the use and quality of OUD treatment in adults with diagnosed disabling conditions, compared with adults without these diagnoses.

Rural-urban prescribing patterns by primary care and behavioral health providers in older adults with serious mental illness.

Background: Older adults with serious mental illness (SMI) often have multiple comorbidities and complex medication schedules. Shortages of behavioral health specialists (BHSs), especially in rural areas, frequently make primary care providers (PCPs) the only clinician managing this complex population. The aim of this study was to describe rural/urban psychiatric medication prescribing in older adults with SMI by PCPs and BHSs, and by clinician type.

Emergency department interventions for opioid use disorder: A synthesis of emerging models.

Introduction: Opioid overdose deaths are increasing, and improving access to evidence-based treatment is necessary. Emergency department (ED) initiation of treatment for opioid use disorder (OUD) via medications and referral to treatment is one approach that leverages a critical health care entry point for individuals with OUD. Efforts to engage patients in treatment through the ED are growing, but systematic analysis of program features as implemented and challenges across different models remains limited.

Opioid use disorder Cascade of care framework design: A roadmap.

Unintentional overdose deaths, most involving opioids, have eclipsed all other causes of US deaths for individuals less than 50 years of age. An estimated 2.4 to 5 million individuals have opioid use disorder (OUD) yet a minority receive treatment in a given year.

Emergency department-based efforts to offer medication treatment for opioid use disorder: What can we learn from current approaches?

Background: The opioid epidemic remains a public health crisis and most people with opioid use disorder (OUD) do not receive effective treatment. The emergency department (ED) can be a critical entry point for treatment. EDs are developing and implementing ED-based efforts to address OUD to improve access to OUD treatment.

Commentary: Moving Toward Clear, Evidence-based, and Effective State Policies for Addiction Medicine.

State policies play a critical role in determining health care delivery, health equity, and health outcomes, but vary widely in scope, target, restrictiveness, and goals. Understanding how such policies impact health care is critical to development of evidence-based policies, but difficult in the absence of organized and standardized approaches to analysis. Development of themes and frameworks for analysis, and identification of policies supported by evidence, are important steps in moving toward more rational and aligned policies.

Cost sharing for breast cancer hormone therapy: How do dual eligible patients' copayment impact adherence.

Objective: To examine the different levels of copayment assistance and treatment adherence among Medicare and Medicaid dual eligible beneficiaries with breast cancer in the U.S.

Research Design: Propensity Score methodology was adopted to minimize potential selection bias from the nonrandom allocation of the treatment group (i.

The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing.

Background/objectives: This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services.

Design: Cluster randomized controlled trial with randomization at the housing site level.

Improving Interorganizational Coordination Between Primary Care and Oncology: Adapting a Chronic Care Management Model for Patients With Cancer.

The objective of this study was to explore the implementation of a payment and delivery system innovation to improve coordination and communication between primary care and oncology. We employed a qualitative case study approach, conducting interviews ( = 18), and reviewing archival materials. Chronic care coordinators and the cancer center social worker acted as boundary spanners.

Addressing Workforce Needs for Medication Treatment of Opioid Use Disorder.

: Medication treatment of opioid use disorder (OUD) is recognized as an effective evidence-based treatment. It has been underused, in part due to challenges in recruiting and retaining a provider workforce that is able to prescribe and manage patients treated with OUD medications. A national goal should be: anyone with an OUD must have adequate access to a range of medications for treatment and support, provided in high-quality settings, and all programs receiving public or private funding should be so equipped.

Predictors of Postdeployment Prescription Opioid Receipt and Long-term Prescription Opioid Utilization Among Army Active Duty Soldiers.

Introduction: Little is known about long-term prescription opioid utilization in the Military Health System. The objectives of this study were to examine predictors of any prescription opioid receipt, and predictors of long-term opioid utilization among active duty soldiers in the year following deployment.

Materials And Methods: The analytic sample consisted of Army active duty soldiers returning from deployment to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn in fiscal years 2008-2014 (N = 540,738).

Applying American Society of Addiction Medicine Performance Measures in Commercial Health Insurance and Services Data.

Objectives: ASAM's Standards of Care for the Addiction Specialist established appropriate care for the treatment of substance use disorders. ASAM identified three high priority performance measures for specification and testing for feasibility in various systems using administrative claims: use of pharmacotherapy for alcohol use disorder (AUD); use of pharmacotherapy for opioid use disorder (OUD); and continuity of care after withdrawal management services. This study adds to the initial testing of these measures in the Veteran's Health Administration (VHA) by testing the feasibility of specifications in commercial insurance data (Cigna).

Prescribing patterns of buprenorphine waivered physicians.

Background: DATA 2000 enabled physicians with approved training to be waivered to prescribe buprenorphine for the treatment of opioid use disorders (OUD) for a limited number of patients. A rule change in 2016 increased the patient limit for certain buprenorphine waivered physicians from 100 to 275. This study examines the prescribing patterns of buprenorphine prescribers by waiver limit status (30- or 100-patient limit).

Specifying and Pilot Testing Quality Measures for the American Society of Addiction Medicine's Standards of Care.

Objectives: In 2013, the American Society of Addiction Medicine (ASAM) approved its Standards of Care for the Addiction Specialist Physician. Subsequently, an ASAM Performance Measures Panel identified and prioritized the standards to be operationalized into performance measures. The goal of this study is to describe the process of operationalizing 3 of these standards into quality measures, and to present the initial measure specifications and results of pilot testing these measures in a large health care system.

Growth in spending on substance use disorder treatment services for the privately insured population.

Background: Approximately 8% of individuals with private health insurance in the United States have substance use disorders (SUDs), but in 2009 only 0.4% of all private insurance spending was on SUDs. The objective of this study was to determine if changes that occurred between 2009 and 2012 - such as more generous SUD benefits, an epidemic of opioid use disorders, and slow recovery from a recession - were associated with greater use of SUD treatment.

Growth in Spending on and Use of Services for Mental and Substance Use Disorders After the Great Recession Among Individuals With Private Insurance.

Objective: Recessions are associated with increased prevalence of mental and substance use disorders, but their effect on use of behavioral health services is less clear. This study examined changes in spending per enrollee for behavioral health services compared with general medical services among individuals with private insurance following the Great Recession that began in 2007.

Methods: The National Survey on Drug Use and Health was used to examine the prevalence of behavioral health conditions among persons with private insurance from 2004 to 2013.

Projected Spending on Psychotropic Medications 2013-2020.

Spending on psychotropic medications has grown rapidly in recent decades. Using national data on drug expenditures, patent expirations, future drug development and expert interviews, we project that spending will grow more slowly over the period 2012-2020. The average annual increase is projected to be just 3.

The diminished pipeline for medications to treat mental health and substance use disorders.

Objective: Psychotropic drug development is perceived to be lagging behind other pharmaceutical development, even though there is a need for more effective psychotropic medications. This study examined the state of the current psychotropic drug pipeline and potential barriers to psychotropic drug development.

Methods: The authors scanned the recent academic and "grey" literature to evaluate psychotropic drug development and to identify experts in the fields of psychiatry and substance use disorder treatment and psychotropic drug development.

Prescriber response to unsolicited prescription drug monitoring program reports in Massachusetts.

Purpose: To describe prescriber response to unsolicited patient reports from the Massachusetts prescription drug monitoring program (PDMP).

Methods: Prescribers were surveyed upon receipt of unsolicited reports of their patients' prescription history and three months later. We assessed prescribers' awareness of other prescribers listed in the report, their clinical assessment of medical necessity of all prescribed medications, actions taken by prescribers after receiving the report, and usefulness of the report.

Medication-assisted treatment with methadone: assessing the evidence.

Objective: Detoxification followed by abstinence has shown little success in reducing illicit opioid use. Methadone maintenance treatment (MMT) helps individuals with an opioid use disorder abstain from or decrease use of illegal or nonmedical opiates. This review examined evidence for MMT's effectiveness.