Medicare beneficiaries in plans without prior authorization experienced fewer hospitalizations and emergency department visits
RESEARCH TRIANGLE PARK, N.C. — A new study in the Journal of the American Medical Association finds that Medicare prescription drug plans that removed prior authorization for common opioid use disorder medications (i.e., buprenorphine-naloxone) saw an increase in the use of those medications as well as a decrease in hospitalizations and emergency department visits for all medical conditions. Conducted by researchers at RTI International, a nonprofit research institute, the study also found that the cost of increased opioid medication usage was more than offset by savings from reduced hospitalizations and emergency department visits.
“This study shows that removing barriers to medications for the treatment of opioid use disorder is not only important from a public health perspective, but also has an economic benefit. Going forward, health plans should account for the impact of prior authorization on total health care costs, not just prescription drug costs, in formulary decisions,“ said Tami Mark, PhD, lead author of the study and senior director of behavioral health financing and quality measurement at RTI.
The research team used claims data from Medicare beneficiaries with opioid use disorder who were enrolled in Medicare Part D plans between 2012–2017. Examining plan use of prior authorization over this period, the research revealed that patients increased their use of buprenorphine-naloxone when authorization requirements were removed and decreased use of the medication when authorization requirements were added. This finding is consistent with previous research of the effect of prior authorization on other types of medications. The removal of prior authorization resulted in a 4% decrease in all nondrug health expenditures, including hospitalizations and ED visits for all health conditions. At the same time, the prescription drug expenditures for buprenorphine increased by only 1%.
“Removing administrative barriers to opioid use disorder medications is critical amidst the dual crises of COVID-19 and the overdose deaths,” said Ellen Weber, vice president of Health Initiatives at the Legal Action Center, a nonprofit law and policy organization working with RTI. She adds, “This study demonstrates that there is no clinical or economic justification for imposing prior authorization on opioid use disorder medications, and in fact, removing this unnecessary requirement is likely to save lives and healthcare dollars.”
More than 46,000 Americans died of opioid overdose deaths in 2018, a 4.6% decline from 2017, but still more than double the deaths from opioid overdose in 2010. Opioid use disorder medications can cut a patient’s risk of death in half and improves other health outcomes. Removing prior authorization is critical to improving access to these life saving medications.
RTI collaborated with the Legal Action Center on the study, which was funded by Arnold Ventures.
To learn more about RTI’s research on treating opioid use disorders, visit: www.rti.org/emerging-issue/opioid-research/treating-opioid-use-disorders.