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Out-of-Pocket Costs and Discontinuation of Buprenorphine Among Privately Insured U.S. Adults With Opioid Use Disorder

Buprenorphine use declined among privately insured American adults with opioid use disorder (OUD) as out-of-pocket (OOP) costs increased, a study shows. “Policies addressing patient-level hurdles within the OUD cascade of care may prevent lasting impact on adverse health outcomes associated with OUD,” the authors write. “The Patient Protection and Affordable Care Act’s preventive drug list mandates private insurance plans cover recommended preventive services without patient cost-sharing. Adding OUD medications to this list could alleviate lasting consequences of the opioid crisis. This approach alongside other state-level, supply-side initiatives (eg, relaxing clinician scope of practice limits and caps on refills) could optimize benefits of sustained OUD therapy.”

Fill rates for buprenorphine by U.S. adults ages 18 to 64 years were estimated using MarketScan Commercial Claims Database records. A primary outcome of time from the index buprenorphine fill until its discontinuation showed these results: “Between 2013 and 2020, 40,035 commercially insured patients initiated buprenorphine for OUD (median [IQR] age, 34 [24-46] y, 25,053 males [62.6%] and 14,982 females [37.4%]). Only 22% of patients continuously used buprenorphine during follow-up, and 6% switched to naltrexone. Median [IQR] time to discontinuation was 64 [22-286.5] days overall and 35 [15-105] days among patients who discontinued within the follow-up period. In adjusted analyses, higher daily OOP costs for the index fill were associated with increased hazard of buprenorphine discontinuation. Compared with the first (lowest) quartile of OOP costs ($0-$0.71), each quartile of higher costs was associated with increasingly higher hazard of discontinuation: second quartile ($0.72-$1.84), adjusted hazard ratio (AHR), 1.09 (95% CI, 1.06-1.13); third quartile ($1.85-$4.27), AHR, 1.18 (95% CI, 1.13-1.22); and fourth quartile ($4.28-$97.50), AHR, 1.34 (95% CI, 1.29-1.39). Compared with sublingual buprenorphine/naloxone film (Suboxone; Reckitt Benckiser Pharmaceuticals), risk of discontinuation was higher with the generic buprenorphine/naloxone film, generic buprenorphine/naloxone tablet, generic buprenorphine tablet, and Suboxone tablet. Additional risk factors included younger age, residing in the Western region vs the North Central region, initiating medication in any month other than January, having other substance use diagnoses, and having physical comorbidities.”

Source: JAMA Internal Medicine