24 Apr Opioid Use Disorder Drugs: Removing Need for Prior Authorization Can Save Money in the Long Run
MedicalResearch.com Interview with:
Tami L. Mark, PhD
Senior Director, Behavioral Health Financing and Quality Measurement
MedicalResearch.com: What is the background for this study?
Response: There are effective medications to treat opioid use disorder. Federal and state policymakers have tried to improve access to these medications. However, medications to treat opioid use disorders are still often subject to prior authorization. Studies of other medications finds that prior authorization can reduce access.
This study looked at whether removing prior authorization in Medicare Part D plans was associated with increases in the use of medications to treat opioid use disorder.
MedicalResearch.com: What are the main findings?
Response: We found a significant increase in both the total number of prescriptions filled as well as the number of persons filling new prescriptions for opioid use disorder medications after prior authorization was removed. We also found that removing prior authorization for medications to treat opioid use disorder was associated with significant decreases in inpatient admissions and emergency department visits, which are costly health care events. Moreover, we found that that on average cost savings associated with fewer inpatient admissions and emergency department visits more than compensated for the increases in prescription drug spending associated with more people taking medications to treat their opioid use disorder.
MedicalResearch.com: What should readers take away from your report?
Response: Health insurance plans use tools like prior authorization as cost control measures. Our study confirms that the use of prior authorization may in fact reduce expenditures for medications to treat opioid use disorder. However, this comes at a significant cost in terms of the health and well-being of persons with opioid use disorder who are more likely to be hospitalized or go to the emergency room when access to medications to treat opioid use disorders is limited.
Moreover, this study suggests that there is a real missed opportunity to achieve cost savings on the medical expenditure side. So there is a strong public health and economic argument in favor of relaxing restrictions to access medications to treat opioid use disorder.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: This study looked at the impact of prior authorization among Medicare beneficiaries. Additional research is needed to understand how prior authorization decisions are being made and how the costs and benefits of prior authorization decisions are evaluated.
We have no disclosures.
Mark TL, Parish WJ, Zarkin GA. Association of Formulary Prior Authorization Policies With Buprenorphine-Naloxone Prescriptions and Hospital and Emergency Department Use Among Medicare Beneficiaries. JAMA Netw Open. 2020;3(4):e203132. doi:10.1001/jamanetworkopen.2020.3132
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