The effect of out-of-pocket costs on medications for opioid use disorder and overdose: A scoping review

The opioid epidemic is a major public health crisis in Canada and elsewhere. The increase in opioid prescriptions is a major contributor to this crisis. Medications for opioid use disorder (OUD) and overdose are effective and lifesaving treatments. Often, patients do not have adequate insurance coverage (or uninsured) for medications for OUD and have to pay out of pocket (OOP). OOP costs (OOPCs) result in financial burdens among patients, limiting their access to medications for OUD, and overdose.

To identify the evidence on (1) the OOPCs of medications for OUD and overdose, and (2) the effect of insurance coverage (or being uninsured) and corresponding OOPCs on medications for OUD initiation, retention, and discontinuation.

This scoping review was conducted in accordance with methodological guidance from the Joanna Briggs Institute. The literature search aimed to identify peer-reviewed publications in English in MEDLINE, Embase, and CINAHL, which were searched from inception to March 22, 2024. Two reviewers independently completed title, abstract, and full-text screening against inclusion criteria. Data extracted were used to describe the body of literature using descriptive and qualitative approaches.

Out of the 2003 search results, a total of ten studies met the inclusion criteria and were included in the review. Uninsured patients have paid higher OOPCs compared to private or publicly insured patients. Among privately insured patients with OUD, greater OOPC may result in poor retention of buprenorphine. The risk of discontinuation was higher with the buprenorphine/naloxone tablet compared with the sublingual buprenorphine/naloxone film. Generic substitution or providing coverage for these medications being dispensed from community pharmacies can potentially minimize the burden of OOPCs and improve access.

The literature highlights beneficiaries of private/commercial health plans experience a substantial burden of OOPCs, creating barriers to treatment initiation, retention, and adherence to medications for OUD.