Despite evidence supporting the effectiveness of medications for opioid use disorder, state funded insurance programs often lack adequate coverage of this treatment option.
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With less restrictive access to these medications relative to other programs, MassHealth offers an opportunity to determine how access to, and use of, these medications may improve treatment outcomes for Medicaid beneficiaries in the long term.
This study by Clark and colleagues used MassHealth data of members age 16 and older with a primary diagnosis of opioid abuse or dependence between 2004 and 2010 to examine the association between type of treatment episode (whether it was buprenorphine/naloxone, methadone, or behavioral health treatment) and relapse rates and total healthcare costs during treatment episodes. Relapse was considered to have occurred if a patient had claims data for detoxification, inpatient admission with a primary diagnosis of substance use disorder (SUD), or an emergency department visit with a primary diagnosis of SUD at some point after the index episode of care.
Between 2004 and 2010, 56,278 individuals received a total of 104,840 episodes of treatment. Members who did not receive medication assisted treatment (MAT) were more likely to have co-occurring mental illness and alcohol use disorders, higher average costs, and more frequent relapses. Episodes of buprenorphine or methadone maintenance treatment were less than half as likely to result in relapse compared to behavioral health treatment (i.e., non-MAT. Individuals with co-occurring alcohol abuse or dependence experienced relapse at four times the rate of those without alcohol abuse or dependence.
Having an addiction to drugs in addition to opioids doubled the risk of relapse. After controlling for factors including treatment history and length of treatment episode, methadone and buprenorphine treatment episodes were associated with lower total health care expenditures compared to behavioral health treatment; this ranged from savings of $153 to $223 per month.
The average per person cost of treatment was $786 higher per month when factoring in co-occurring severe mental illness, alcohol use disorders, and other drug use disorders.
If the data from Massachusetts’ Medicaid program, known as MassHealth, support its use, other state Medicaid programs may choose to reimburse for this treatment modality consistent with the evidence base (e.g., like other chronic health conditions, such as diabetes) and potentially to improve access to care with fewer barriers to accessing it.
Comorbidity or co-occurring conditions increased risk of relapse and total healthcare expenditures. Medication assisted treatment (MAT) alone may not be suitable for patients with more severe mental health problems.
Next steps should address how to increase access to these medications in other state Medicaid programs. A qualitative study of policy makers in Ohio identified some barriers to implementing buprenoprhine/naloxone treatment (e.g., limited availability of prescribers), but more quantitative research including cost-effectiveness analyses are needed to bolster support for medications for the treatment of opioid use disorder.
Clark, R. E., Baxter, J. D., Aweh, G., O’Connell, E., Fisher, W. H., & Barton, B. A. (2015). Risk Factors for Relapse and Higher Costs Among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities, and Treatment History. J Subst Abuse Treat, 57, 75-80. doi:10.1016/j.jsat.2015.05.001
l
With less restrictive access to these medications relative to other programs, MassHealth offers an opportunity to determine how access to, and use of, these medications may improve treatment outcomes for Medicaid beneficiaries in the long term.
This study by Clark and colleagues used MassHealth data of members age 16 and older with a primary diagnosis of opioid abuse or dependence between 2004 and 2010 to examine the association between type of treatment episode (whether it was buprenorphine/naloxone, methadone, or behavioral health treatment) and relapse rates and total healthcare costs during treatment episodes. Relapse was considered to have occurred if a patient had claims data for detoxification, inpatient admission with a primary diagnosis of substance use disorder (SUD), or an emergency department visit with a primary diagnosis of SUD at some point after the index episode of care.
Between 2004 and 2010, 56,278 individuals received a total of 104,840 episodes of treatment. Members who did not receive medication assisted treatment (MAT) were more likely to have co-occurring mental illness and alcohol use disorders, higher average costs, and more frequent relapses. Episodes of buprenorphine or methadone maintenance treatment were less than half as likely to result in relapse compared to behavioral health treatment (i.e., non-MAT. Individuals with co-occurring alcohol abuse or dependence experienced relapse at four times the rate of those without alcohol abuse or dependence.
Having an addiction to drugs in addition to opioids doubled the risk of relapse. After controlling for factors including treatment history and length of treatment episode, methadone and buprenorphine treatment episodes were associated with lower total health care expenditures compared to behavioral health treatment; this ranged from savings of $153 to $223 per month.
The average per person cost of treatment was $786 higher per month when factoring in co-occurring severe mental illness, alcohol use disorders, and other drug use disorders.
If the data from Massachusetts’ Medicaid program, known as MassHealth, support its use, other state Medicaid programs may choose to reimburse for this treatment modality consistent with the evidence base (e.g., like other chronic health conditions, such as diabetes) and potentially to improve access to care with fewer barriers to accessing it.
Comorbidity or co-occurring conditions increased risk of relapse and total healthcare expenditures. Medication assisted treatment (MAT) alone may not be suitable for patients with more severe mental health problems.
Next steps should address how to increase access to these medications in other state Medicaid programs. A qualitative study of policy makers in Ohio identified some barriers to implementing buprenoprhine/naloxone treatment (e.g., limited availability of prescribers), but more quantitative research including cost-effectiveness analyses are needed to bolster support for medications for the treatment of opioid use disorder.
Clark, R. E., Baxter, J. D., Aweh, G., O’Connell, E., Fisher, W. H., & Barton, B. A. (2015). Risk Factors for Relapse and Higher Costs Among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities, and Treatment History. J Subst Abuse Treat, 57, 75-80. doi:10.1016/j.jsat.2015.05.001
l
With less restrictive access to these medications relative to other programs, MassHealth offers an opportunity to determine how access to, and use of, these medications may improve treatment outcomes for Medicaid beneficiaries in the long term.
This study by Clark and colleagues used MassHealth data of members age 16 and older with a primary diagnosis of opioid abuse or dependence between 2004 and 2010 to examine the association between type of treatment episode (whether it was buprenorphine/naloxone, methadone, or behavioral health treatment) and relapse rates and total healthcare costs during treatment episodes. Relapse was considered to have occurred if a patient had claims data for detoxification, inpatient admission with a primary diagnosis of substance use disorder (SUD), or an emergency department visit with a primary diagnosis of SUD at some point after the index episode of care.
Between 2004 and 2010, 56,278 individuals received a total of 104,840 episodes of treatment. Members who did not receive medication assisted treatment (MAT) were more likely to have co-occurring mental illness and alcohol use disorders, higher average costs, and more frequent relapses. Episodes of buprenorphine or methadone maintenance treatment were less than half as likely to result in relapse compared to behavioral health treatment (i.e., non-MAT. Individuals with co-occurring alcohol abuse or dependence experienced relapse at four times the rate of those without alcohol abuse or dependence.
Having an addiction to drugs in addition to opioids doubled the risk of relapse. After controlling for factors including treatment history and length of treatment episode, methadone and buprenorphine treatment episodes were associated with lower total health care expenditures compared to behavioral health treatment; this ranged from savings of $153 to $223 per month.
The average per person cost of treatment was $786 higher per month when factoring in co-occurring severe mental illness, alcohol use disorders, and other drug use disorders.
If the data from Massachusetts’ Medicaid program, known as MassHealth, support its use, other state Medicaid programs may choose to reimburse for this treatment modality consistent with the evidence base (e.g., like other chronic health conditions, such as diabetes) and potentially to improve access to care with fewer barriers to accessing it.
Comorbidity or co-occurring conditions increased risk of relapse and total healthcare expenditures. Medication assisted treatment (MAT) alone may not be suitable for patients with more severe mental health problems.
Next steps should address how to increase access to these medications in other state Medicaid programs. A qualitative study of policy makers in Ohio identified some barriers to implementing buprenoprhine/naloxone treatment (e.g., limited availability of prescribers), but more quantitative research including cost-effectiveness analyses are needed to bolster support for medications for the treatment of opioid use disorder.
Clark, R. E., Baxter, J. D., Aweh, G., O’Connell, E., Fisher, W. H., & Barton, B. A. (2015). Risk Factors for Relapse and Higher Costs Among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities, and Treatment History. J Subst Abuse Treat, 57, 75-80. doi:10.1016/j.jsat.2015.05.001
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