Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017

Haiden A. Huskamp, Lauren E. Riedel, Colleen L Barry, Alisa B. Busch

Research output: Contribution to journalArticle

Abstract

Background: Efficacious medications to treat opioid use disorders (OUDs) have been slow to diffuse into practice, and insurance coverage limits may be one important barrier. Objectives: To compare coverage for medications used to treat OUDs and opioids commonly prescribed for pain management in plans offered on the 2017 Health Insurance Marketplace exchanges. Research Design: We identified a sample of 100 plans offered in urban and in rural counties on the 2017 Marketplaces, weighting by population. We accessed publicly available plan coverage information on healthcare.gov for states with a federally facilitated exchange, the state exchange website for state-based exchanges, and insurer websites. Results: About 14% of plans do not cover any formulations of buprenorphine/naloxone. Plans were more likely to require prior authorization for any of the covered office-based buprenorphine or naltrexone formulations preferred for maintenance OUD treatment (ie, buprenorphine/naloxone, buprenorphine implants, injectable long-Acting naltrexone) than of short-Acting opioid pain medications (63.6% vs. 19.4%; P<0.0001). Only 10.6% of plans cover implantable buprenorphine, 26.1% cover injectable naltrexone, and 73.4% cover at least 1 abuse-deterrent opioid pain medication. Conclusions: Many Marketplace plans either do not cover or require prior authorization for coverage of OUD medications, and these restrictions are often more common for OUD medications than for short-Acting opioid pain medications. Regulators tasked with enforcement of the Mental Health Parity and Addiction Equity Act, which requires that standards for formulary design for mental health and substance use disorder drugs be comparable to those for other medications, should focus attention on formulary coverage of OUD medications.

Original languageEnglish (US)
Pages (from-to)505-509
Number of pages5
JournalMedical Care
Volume56
Issue number6
DOIs
StatePublished - Jan 1 2018

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Pain Management
Opioid Analgesics
Buprenorphine
Naltrexone
Health Insurance Exchanges
Formularies
Pain
Mental Health
Insurance Carriers
Injections
Insurance Coverage
Parity
Substance-Related Disorders
Research Design
Maintenance
Delivery of Health Care

Keywords

  • insurance coverage
  • medications
  • substance use disorder

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017. / Huskamp, Haiden A.; Riedel, Lauren E.; Barry, Colleen L; Busch, Alisa B.

In: Medical Care, Vol. 56, No. 6, 01.01.2018, p. 505-509.

Research output: Contribution to journalArticle

Huskamp, Haiden A. ; Riedel, Lauren E. ; Barry, Colleen L ; Busch, Alisa B. / Coverage of Medications That Treat Opioid Use Disorder and Opioids for Pain Management in Marketplace Plans, 2017. In: Medical Care. 2018 ; Vol. 56, No. 6. pp. 505-509.
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