Trends in Buprenorphine Coverage and Prior Authorization Requirements in US Commercial Formularies, 2017-2021

Nguyễn, Thủy; Chua, Kao-Ping; Andraka‐Christou, Barbara; Bradford, W. David; Simon, Kosali

doi:10.1001/jamahealthforum.2022.1821

Cited by 5 publications

(1 citation statement)

References 6 publications

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“…6 Buprenorphine/naloxone is commonly the preferred formulation of insurance plans; among US commercial formularies in 2021, 93.1% covered generic buprenorphine/naloxone lms without prior authorization, compared with 75.8% for generic buprenorphine tablets. 7 Despite low bioavailability with SL administration, naloxone is detectable in nearly all patients taking sublingual buprenorphine/naloxone, 8,9 though the value of urine naloxone that is clinically meaningful remains unknown. Even with detectable naloxone levels, the combined buprenorphine/naloxone is still effective treatment for OUD because of the relatively higher binding a nity of buprenorphine at the µopioid receptor as compared to naloxone.…”

Section: Introductionmentioning

confidence: 99%

Buprenorphine/naloxone – One formulation that doesn’t fit all: A case report

Braun,

Taylor,

Axelrath

2024

Preprint

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Background Sublingual buprenorphine, approved for treatment of opioid use disorder since 2002, is most commonly available in co-formulation with naloxone. Naloxone is an opioid antagonist minimally absorbed when sublingual (SL) buprenorphine/naloxone is taken as prescribed; it is thought to reduce potential for misuse via intravenous administration. However, growing data and clinical experience demonstrate that previously accepted assumptions about the pharmacokinetics of these medications may not apply to all patients. Case presentation We present a patient whose adverse post-administration side effects on SL buprenorphine/naloxone resolved with transition to SL buprenorphine monoproduct. Discussion Naloxone can be detected in nearly all patients taking SL buprenorphine/naloxone, though with apparent variability in clinical effect. In a minority of patients, naloxone can contribute to adverse and potentially treatment-limiting side effects. Furthermore, the naloxone component is commonly misunderstood by patients and providers and can foster mistrust in the therapeutic relationship if providers are perceived to be withholding a more tolerable formulation. Prescribers should have a low threshold to offer buprenorphine alone when clinically appropriate.

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Section: Introductionmentioning

confidence: 99%

Buprenorphine/naloxone – One formulation that doesn’t fit all: A case report

Braun,

Taylor,

Axelrath

2024

Preprint

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Prior authorization restrictions on medications for opioid use disorder: trends in state laws from 2005 to 2019

et al. 2023

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US payment policy for medications to treat opioid use disorder: landscape and opportunities

McGinty,

White,

Eisenberg

et al. 2024

Health Affairs Scholar

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Offering patients medications for opioid use disorder (MOUD) is the standard of care for opioid use disorder (OUD), but an estimated 75-90% of people with OUD who could benefit from MOUD do not receive medication. Payment policy, defined as public and private payers’ approaches to covering and reimbursing providers for MOUD, is one contributor to this treatment gap. We conducted a policy analysis and qualitative interviews (N=21) and surveys (N=31) with U.S. MOUD payment policy experts to characterize MOUD insurance coverage across major categories of U.S. insurers and identify opportunities for reform and innovation. Traditional Medicare, Medicare Advantage, and Medicaid all provide coverage for at least one formulation of buprenorphine, naltrexone, and methadone for OUD. Private insurance coverage varies by carrier and by plan, with methadone most likely to be excluded. The experts interviewed cautioned against rigid reimbursement models that force patients into one-size-fits-all care and endorsed future development and adoption of value-based MOUD payment models. More than 70% of experts surveyed reported that Medicare, Medicaid, and private insurers should increase payment for office- and opioid treatment program-based MOUD. Validation of MOUD performance metrics is needed to support future value-based initiatives.

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Trends in Buprenorphine Coverage and Prior Authorization Requirements in US Commercial Formularies, 2017-2021

Abstract: This cross-sectional study assesses buprenorphine coverage and prior authorization requirements in US commercial formulary data from 2017 to 2021.

Cited by 5 publications

References 6 publications

Buprenorphine/naloxone – One formulation that doesn’t fit all: A case report

Buprenorphine/naloxone – One formulation that doesn’t fit all: A case report

Prior authorization restrictions on medications for opioid use disorder: trends in state laws from 2005 to 2019

US payment policy for medications to treat opioid use disorder: landscape and opportunities

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