国家医疗补助的专题分析 布普伦诺芬 预先授权要求
Max Jordan Nguemeni Tiako1,2,3, Abby Dolan2,3,4, Matthew Abrams2,5
1Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
对于用于治疗阿片类药物使用障碍 (OUD) 的布普伦诺芬,州医疗补助事先授权包括限制性要求. 这些障碍与基于证据的护理相冲突,并阻碍了OUD治疗的努力.
科学领域:
- 成 药物 药物 药物 药物
- 医疗保健服务研究 医疗服务研究
- 质量健康研究 质量健康研究
背景情况:
- 布普伦诺芬的先前授权 (PA) 与减少阿片类药物使用障碍 (OUD) 的治疗有关.
- 虽然医疗保险取消了布普伦诺芬的PA,但许多医疗补助计划保留了这些要求.
- 了解州特定的医疗补助PA要求对于改善获得OUD治疗至关重要.
研究的目的:
- 在州医疗补助计划中分析和分类布普伦诺芬的先前授权 (PA) 要求.
- 确定州医疗补助PA形式中存在的共同主题和障碍.
主要方法:
- 对50个州的布普伦诺芬医疗补助PA表格进行定性主题分析 (2020年11月-2021年3月).
- 评估了表格的特征,以创建对布普伦诺芬获取障碍的障碍.
- 一个编码工具专注于行为健康任务,药物查和剂量限制.
主要成果:
- 大多数州要求至少有一种布普伦诺芬配方的PA,但对于布普伦诺芬-纳洛来说并不典型.
- 确定的主题包括限制性监测 (药物查,药丸计数),行为健康任务,限制医疗决策 (剂量限制) 和患者教育.
- 很大比例的州强制进行药物查 (11-22%),治疗 (14%),并强制实施最大剂量 (36%),其中许多州需要额外的步骤来获得更高的剂量 (22%).
结论:
- 国家医疗补助局对布普伦诺芬的PA要求存在重大障碍,包括监视,强制性治疗和剂量限制.
- 这些PA要求与OUD治疗的基于证据的做法相矛盾.
- 鉴定的障碍可能会阻碍国家努力应对阿片类药物过量危机.
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