Payer policy behavior towards opioid pharmacotherapy treatment in Ohio

Todd Molfenter, Carol Sherbeck, Sandy Starr, Jee Seon Kim, Mark Zehner, Andrew Quanbeck, Nora Jacobson, Dennis McCarty

Research output: Contribution to journalArticle

Abstract

Objective: Few studies examine how payers address the need for improved access to pharmacotherapy for opioid use disorders and the influence of environmental variables on access to opioid agonist and antagonist medications. Method: The 52 Ohio Addiction Drug Abuse and Mental Health Services (ADAMHS) Boards that disburse funds for treatment services for the uninsured and underinsured were surveyed to assess coverage for opioid agonist and antagonist treatment medications. Analyses examined public health data on regional opioid addiction patterns, characteristics of the local health insurance market, and their associations with coverage for opioid addiction pharmacotherapy. Results: Most (70%) of the 44 participating ADAMHS Boards paid for opioid treatment medications. For payment policy, all Boards required behavioral therapy to be provided in conjunction with opioid agonist or opioid antagonist therapy, and 27% of the Boards limited length of a buprenorphine therapy regimen. Higher local opioid treatment admission rates were associated with higher rates of Board funding for opioid treatment pharmacotherapy. Environmental variables (eg, overdose fatality rates or the behaviors of private insurance payers) were not associated with ADAMHS support for opioid agonist or antagonist medication. Conclusions: The analysis highlights the policy preferences of these payers. Follow-up studies should examine the payer decision-making processes, preferences, and attitudes that affect support for pharmacotherapy for opioid dependence.

Original languageEnglish (US)
Pages (from-to)85-91
Number of pages7
JournalJournal of Addiction Medicine
Volume12
Issue number2
DOIs
StatePublished - Jan 1 2018

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Opioid Analgesics
Drug Therapy
Health Services Misuse
Narcotic Antagonists
Mental Health Services
Substance-Related Disorders
Therapeutics
Buprenorphine
Policy Making
Financial Management
Health Insurance
Insurance
Decision Making
Public Health

Keywords

  • addiction payer policy
  • medication-assisted treatment
  • opioid addiction

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Payer policy behavior towards opioid pharmacotherapy treatment in Ohio. / Molfenter, Todd; Sherbeck, Carol; Starr, Sandy; Kim, Jee Seon; Zehner, Mark; Quanbeck, Andrew; Jacobson, Nora; McCarty, Dennis.

In: Journal of Addiction Medicine, Vol. 12, No. 2, 01.01.2018, p. 85-91.

Research output: Contribution to journalArticle

Molfenter, T, Sherbeck, C, Starr, S, Kim, JS, Zehner, M, Quanbeck, A, Jacobson, N & McCarty, D 2018, 'Payer policy behavior towards opioid pharmacotherapy treatment in Ohio', Journal of Addiction Medicine, vol. 12, no. 2, pp. 85-91. https://doi.org/10.1097/ADM.0000000000000369
Molfenter T, Sherbeck C, Starr S, Kim JS, Zehner M, Quanbeck A et al. Payer policy behavior towards opioid pharmacotherapy treatment in Ohio. Journal of Addiction Medicine. 2018 Jan 1;12(2):85-91. https://doi.org/10.1097/ADM.0000000000000369
Molfenter, Todd ; Sherbeck, Carol ; Starr, Sandy ; Kim, Jee Seon ; Zehner, Mark ; Quanbeck, Andrew ; Jacobson, Nora ; McCarty, Dennis. / Payer policy behavior towards opioid pharmacotherapy treatment in Ohio. In: Journal of Addiction Medicine. 2018 ; Vol. 12, No. 2. pp. 85-91.
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