Medical care · 2026
Continuity of Medications for Opioid Use Disorder in States With and Without Medicaid Prescription Cap Policies.
СтатьяНазвание и аннотация: Перевод в очереди
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Dow Patience M, George Miriam, Hughes Landon D, Shireman Theresa I, Donohue Julie M, Andrews Christina M, Peterson Lisa, Hughto Jaclyn M W
Аннотация
BACKGROUND: Medicaid prescription cap policies persist in 12 states; however, it is unclear how they affect the quality of opioid use disorder (OUD) treatment.
OBJECTIVES: To examine the association between cap policies and the continuity in receipt of medication for OUD (MOUD) treatment in Medicaid.
METHODS: Using 2016-2021 T-MSIS Analytical Files data from 37 states, we identified nondual adult (18-64 y) Medicaid enrollees diagnosed with OUD who received MOUD. The exposure was the state's Medicaid prescription cap policy status. The main outcome was a binary variable for MOUD continuity, overall and by type, defined as no treatment gap exceeding 7 consecutive days during a 180-day observation period. We estimated risk ratios for MOUD continuity using modified Poisson regression models, adjusting for individual and state-level covariates to test associations.
RESULTS: Nearly half the sample was female, and the mean age was 37 years. MOUD continuity ranged from 40.7% to 44.3% in states without cap policies and 37.5%-39.6% in cap states. Compared with enrollees in noncap states, those in cap states had a 12% higher likelihood of experiencing at least 1 MOUD treatment gap [risk ratio (RR)=1.12; 95% CI: 1.12-1.13]. These findings were consistent for buprenorphine and methadone. Factors associated with overall MOUD discontinuity included younger age, male sex, living in nonmetropolitan areas, and having 3 or more comorbidities.
CONCLUSIONS: Prescription caps were associated with reduced continuity of MOUD, overall and for buprenorphine and methadone, suggesting that revising or removing these policies could improve OUD quality metrics in Medicaid.
OBJECTIVES: To examine the association between cap policies and the continuity in receipt of medication for OUD (MOUD) treatment in Medicaid.
METHODS: Using 2016-2021 T-MSIS Analytical Files data from 37 states, we identified nondual adult (18-64 y) Medicaid enrollees diagnosed with OUD who received MOUD. The exposure was the state's Medicaid prescription cap policy status. The main outcome was a binary variable for MOUD continuity, overall and by type, defined as no treatment gap exceeding 7 consecutive days during a 180-day observation period. We estimated risk ratios for MOUD continuity using modified Poisson regression models, adjusting for individual and state-level covariates to test associations.
RESULTS: Nearly half the sample was female, and the mean age was 37 years. MOUD continuity ranged from 40.7% to 44.3% in states without cap policies and 37.5%-39.6% in cap states. Compared with enrollees in noncap states, those in cap states had a 12% higher likelihood of experiencing at least 1 MOUD treatment gap [risk ratio (RR)=1.12; 95% CI: 1.12-1.13]. These findings were consistent for buprenorphine and methadone. Factors associated with overall MOUD discontinuity included younger age, male sex, living in nonmetropolitan areas, and having 3 or more comorbidities.
CONCLUSIONS: Prescription caps were associated with reduced continuity of MOUD, overall and for buprenorphine and methadone, suggesting that revising or removing these policies could improve OUD quality metrics in Medicaid.