医疗补助的终结和布普伦诺啡因分配的变化
Joanne Constantin1, Genevieve M Kenney2, Kosali Simon3
1Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor.
JAMA network open
|May 2, 2025
概括
医疗补助计划的解开扰乱了数百万人的布普伦诺芬治疗,增加了阿片类药物使用障碍并发症的风险. 患者转向私人保险或现金,表明治疗缺口和可能增加与阿片类药物相关的危害.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
- 药理学 药理学是指药理学的学科.
背景情况:
- 医疗补助持续入学条款的终止导致了广泛的医疗补助退学,被称为"医疗补助退学".
- 布普伦诺芬是治疗阿片类药物使用障碍 (OUD) 的关键药物,有助于预防致命的阿片类药物过量服用.
- 医疗补助公司解散对布普伦诺芬发行的影响仍未得到审查.
研究的目的:
- 调查医疗补助持续入学条款结束后,布普伦诺芬发行模式的变化.
- 评估医疗补助的终止与布普伦诺芬治疗的连续性之间的关联.
主要方法:
- 一项采用IQVIA纵向处方数据库 (涵盖美国92%的零售处方) 的差异分析的横截面研究.
- 州的比较与成年人医疗补助入学率最高和最低的百分比变化,从退休前到2023年12月.
- 分析2017年至2023年医疗补助保险成年人中布普伦诺芬处方结果,包括有效处方日,转向私人保险和现金支付.
主要成果:
- 与对照状态相比,经历了显著的医疗补助退学 (治疗状态) 的州显示,与控制状态相比,活跃布普伦诺芬处方日数的减少更大 (-3.9天).
- 在治疗状态 (1.8个百分点) 中,观察到没有活跃布普伦诺芬处方的可能性更高.
- 在治疗状态下,转向私人保险 (1.9个百分点) 或现金支付 (0.9个百分点) 的布普伦诺芬增加.
结论:
- 医疗补助的取消与布普伦诺芬治疗的重大中断有关.
- 干扰包括减少布普伦诺芬的使用和转向替代支付方式,可能会危及OUD治疗.
- 这些发现引发了人们对先前被Medicaid覆盖的弱势群体中阿片类药物相关的发病率和死亡率增加的担忧.
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