Removal of prior authorization for medication-assisted treatment: Impact on opioid use and policy implications in a Medicare Advantage population

• Main Authors: Bizzell, B. (Author), Ferries, E. (Author), Racsa, P. (Author), Rhodes, C. (Author), Suehs, B. (Author)
• Format: Article
• Language: English
• Published: Academy of Managed Care Pharmacy (AMCP) 2021
• Subjects: adult; Adult; aged; Aged; Aged, 80 and over; Analgesics, Opioid; anticonvulsive agent; antidepressant agent; Article; behavior disorder; benzodiazepine derivative; buprenorphine plus naloxone; clinical evaluation; clinical outcome; cohort analysis; controlled study; Cross-Sectional Studies; cross-sectional study; drug dependence treatment; drug misuse; drug use; emergency ward; female; Female; glucocorticoid; health care policy; health care utilization; health service; hospital admission; hospital patient; human; Humans; incidence; low drug dose; major clinical study; male; Male; medicare; Medicare Part C; medication assisted treatment; mental disease; middle aged; Middle Aged; morphine; muscle relaxant agent; naltrexone; narcotic analgesic agent; nonsteroid antiinflammatory agent; opiate; opiate addiction; organizational policy; Organizational Policy; population; prescription; prescription drug; prior authorization; Prior Authorization; recurrence risk; Retrospective Studies; retrospective study; treatment outcome; United States; very elderly; young adult; Young Adult
• Online Access: View Fulltext in Publisher

 BACKGROUND: More than 30% of Medicare beneficiaries and 40% of patients dually eligible for Medicare and Medicaid use opioids. With an estimated 8%-12% of patients developing an opioid use disorder (OUD) after initiating opioids, opioid misuse is a significant public health challenge, especially among high-risk Medicare populations. Medication-assisted treatment (MAT) is the use of medications for the treatment of OUD and to prevent relapse to opioid use. MAT is the most effective treatment for OUD. There are a variety of barriers to MAT therapy that may delay access to treatment. OBJECTIVE: To study the impact of the removal of prior authorization requirements for MAT medications on MAT utilization, opioid utilization, and clinical outcomes, including emergency department visits, inpatient admission, relapse rates, behavioral health services, and nonopioid pain medication utilization, among opioid-using individuals with Medicare Advantage Prescription Drug (MAPD) coverage. METHODS: This retrospective, cross-sectional study used administrative medical, pharmacy, and enrollment data to identify chronic opioid users and a subset cohort initiating MAT use in 2017, when prior authorization requirements were in effect, and 2018 after removal of prior authorization requirements. Opioid and MAT utilization and clinical outcomes from emergency department visits were also examined before and after prior authorization requirements. A logistic regression analysis was conducted to examine the impact of the policy change on relapse rates, comparing relapse rates in 2017 and 2018, after controlling for potentially confounding demographic and clinical factors. RESULTS: This policy change was followed by a decrease in opioid utilization, an increase in MAT initiation, and a 4% decline in relapse rates. Patients initiating MAT after removal of prior authorizations had a 19% decrease in likelihood of relapse, and those with an OUD diagnosis were 47% less likely to relapse. The majority of MAT recipients were aged younger than 65 years, had a mental or behavioral health disorder diagnosis, and initially used relatively low doses (< 90 MME) of prescription opioids. There were no statistically significant differences in the use of behavioral health services or the use of nonopioid medications from 2017 to 2018. CONCLUSIONS: Utilization management policies should ensure appropriate MAT use, while minimizing impediments to access. Providing patients with evidence-based therapy effective for the treatment of OUD is essential to patient recovery and combating the consequences of the opioid epidemic. Further strides are needed to eliminate additional obstacles to OUD care. © 2021 Academy of Managed Care Pharmacy (AMCP). All rights reserved.