取消医疗补助事先授权要求和阿片类药物使用障碍的布普伦诺芬治疗
Paul J Christine1, Marc R Larochelle2,3, Lewei Allison Lin4,5
1Section of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora.
JAMA health forum
|October 20, 2023
概括
在医疗补助计划中取消布普伦诺芬的先前授权并没有增加阿片类药物使用障碍 (OUD) 的整体处方. 然而,最初布普伦诺芬使用较低的州在政策变化后处方量增加.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 药物使用障碍 药物使用障碍
- 卫生政策 卫生政策
背景情况:
- 布普伦诺芬对阿片类药物使用障碍 (OUD) 有效,降低死亡率和发病率.
- 尽管有好处,但有限的布普伦诺芬吸收仍然存在,可能是由于政策障碍,如事先授权 (PA).
- 关于PA影响的研究,特别是在医疗补助人口中,很少.
研究的目的:
- 为了确定是否取消Medicaid对布普伦诺芬的先前授权 (PA) 政策与布普伦诺芬处方率的变化有关.
- 分析PA移除和医疗补助计划注册人群中布普伦诺芬处方趋势之间的关联.
主要方法:
- 国家一级,连续的横截面研究,利用2015-2019年季度数据.
- 在那些取消了医疗补助PA的州比较了布普伦诺芬处方与那些维持它们的州.
- 包括23个具有可比的PA政策和足够的政策前后数据的州.
主要成果:
- 删除医疗补助PA与布普伦诺芬处方的整体增加没有关联.
- 处方量低于基线中位数的州在去除PA后出现显著增加 (40.1%).
- 处方量高于基线中位数的州没有显著变化.
结论:
- 取消Medicaid对布普伦诺芬的预先授权并没有导致处方的广泛增加.
- 在历史上布普伦诺芬利用率较低的州观察到有针对性的增加.
- 持续努力至关重要,以减少障碍,并改善OUD对布普伦诺芬的获取.
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