医疗补助扩张和布普伦诺芬在早期与最近扩张州的分配
Nicole Siegal1, Sumedha Gupta2, Jennifer Miles3,4
1O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington.
JAMA network open
|February 18, 2026
概括
医疗补助的扩张,特别是在2018年之后,显著增加了对阿片类药物使用障碍 (OUD) 的布普伦诺芬治疗的获取. 这种改善在需要高的州采用新的处方法规时最为显著.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 药物使用障碍治疗 药物使用障碍治疗
背景情况:
- 患者保护和可负担医疗法案 (ACA) 的医疗补助扩展旨在改善医疗保健的获取,包括阿片类药物使用障碍 (OUD) 治疗.
- 关于2018年后医疗补助扩张对人口水平布普伦诺芬治疗率的影响的证据有限,特别是使用现代分析方法并考虑付款人特定的结果.
研究的目的:
- 在所有扩张州评估医疗补助扩张和布普伦诺芬治疗率之间的关联,分析整体和付款人特定的趋势.
- 确定2018年后的扩张,与X豁免的取消和远程医疗的兴起相吻合,与早期的扩张相比,是否有不同的影响.
主要方法:
- 一项横截面研究分析了从2013年到2024年在51个美国司法管辖区使用IQVIA纵向处方数据库分发布普伦诺芬的数据.
- 使用差异差异分析来评估与逐步采用医疗补助扩张相关的每月布普伦诺芬治疗率的变化.
主要成果:
- 医疗补助扩张与整体布普伦诺芬治疗率的21.1%的相对增加有关,特别是在2019年或之后扩大医疗补助的州.
- 治疗率的显著增加在最近的高需求扩张的州被观察到,包括缅因州 (每10万人口中有57.22人),弗吉尼亚州 (每10万人口中有44.46人) 和俄克拉荷马州 (每10万人口中有22.98人).
结论:
- 2018年后的医疗补助扩张与阿片类药物使用障碍的布普伦诺芬治疗的实质性改善有关,特别是在最近扩张和不断变化的处方法规的州.
- 这些发现突出了医疗补助扩张在提高获得基于证据的OUD治疗的关键作用,并可以在州和联邦层面为未来的政策决策提供信息.
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