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  1. Home
  2. State Drug Caps Associated With Fewer Medicaid-covered Prescriptions For Opioid Use Disorder, 2017-2022.
  1. Home
  2. State Drug Caps Associated With Fewer Medicaid-covered Prescriptions For Opioid Use Disorder, 2017-2022.

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State drug caps associated with fewer Medicaid-covered prescriptions for opioid use disorder, 2017-2022.

Robert J Besaw1, Carrie E Fry1

  • 1Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN 37203, United States.

Health Affairs Scholar
|December 16, 2024

View abstract on PubMed

Summary
This summary is machine-generated.

Medicaid prescription drug caps significantly reduce access to medications for opioid use disorder (OUD). These policies may hinder efforts to combat the ongoing opioid crisis by limiting essential MOUD prescriptions.

Keywords:
Medicaidhealth policyopioid use disorderprescription drugsprior authorizationsubstance use

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Area of Science:

  • Health Services Research
  • Public Health Policy
  • Substance Use Disorder Treatment

Background:

  • Medicaid is a primary payer for opioid use disorder (OUD) treatment.
  • Budget constraints lead some Medicaid programs to implement prescription drug caps.
  • These caps limit the monthly number of prescriptions an enrollee can fill.

Purpose of the Study:

  • To examine the association between Medicaid prescription drug caps and filled prescriptions for medications for OUD (MOUD).
  • To analyze the impact of varying prescription drug cap limits on MOUD access.

Main Methods:

  • Utilized Medicaid fee-for-service and managed care data from 2017-2022.
  • Employed multivariate linear regression to analyze prescription data from ten states with drug caps.
  • Assessed the association between monthly prescription drug caps (3-6 prescriptions) and MOUD prescriptions filled.
  • Main Results:

    • States with monthly prescription drug caps showed 1489.3 fewer MOUD prescriptions per 100,000 enrollees.
    • Higher drug caps (4, 5, or 6) were associated with more filled MOUD prescriptions compared to 3-drug caps.
    • Results remained robust across sensitivity analyses.

    Conclusions:

    • Monthly prescription drug caps are significantly linked to reduced Medicaid-covered MOUD prescriptions.
    • Indiscriminate prescription drug cap policies may negatively impact Medicaid enrollees requiring MOUD.
    • These policies could impede current strategies to mitigate the opioid crisis.