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Medication Utilization for Alcohol Use Disorder in a Commercially Insured Population
Haiden A Huskamp1, Sharon Reif2, Shelly F Greenfield3,4
1Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA. huskamp@hcp.med.harvard.edu.
Journal of General Internal Medicine
|August 6, 2020
Summary
Few individuals with alcohol use disorder (AUD) receive medication, despite increased use in recent years and among those with severe AUD. More proactive identification and treatment in non-acute settings are needed.
Area of Science:
- Health Services Research
- Addiction Medicine
- Pharmacoeconomics
Background:
- Alcohol Use Disorder (AUD) is a chronic relapsing condition requiring multifaceted treatment approaches.
- Medication plays a crucial role in managing AUD, yet prescription patterns and fill rates remain understudied.
- Understanding factors influencing medication adherence is vital for improving patient outcomes and healthcare resource allocation.
Purpose of the Study:
- To analyze trends in AUD medication prescription fills among commercially insured individuals.
- To identify demographic, clinical, and healthcare system factors associated with the initiation of AUD pharmacotherapy.
- To evaluate the impact of insurance benefit duration on medication access.
Main Methods:
- A retrospective cohort study using 2008-2018 claims data from a large national insurer.
- Inclusion criteria: individuals aged 17-64 with at least one AUD diagnosis visit.
- Cause-specific hazards modeling was employed to estimate time to first AUD medication fill, accounting for benefit loss as a competing risk.
Main Results:
- Only 13.3% of 151,128 individuals with an index AUD visit filled an AUD prescription; 69.8% lost insurance benefits before filling.
- Medication fill likelihood increased with AUD severity, co-occurring opioid use disorder (OUD), severe mental illness, and in later study years.
- Factors associated with lower fill rates included male sex, diagnosis of SUD other than AUD/OUD, and acute alcohol-related conditions.
Conclusions:
- Despite an increase in AUD medication use, particularly for severe cases, overall fill rates remain low, with a significant proportion losing insurance coverage before treatment initiation.
- There is a critical need for enhanced strategies to identify and engage patients in non-acute care settings for earlier medication-based treatment.
- Optimizing access to AUD pharmacotherapy requires addressing barriers related to insurance coverage and healthcare delivery models.
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