Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #116232

Dominic Hodgkin, PhD¹, Constance M. Horgan, ScD², Elizabeth L. Merrick, PhD, MSW, Deborah W. Garnick, ScD⁴, and Joanna Volpe-Vartanian, MS, LICSW⁵. (1) Schneider Institute for Health Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, 781-736-8551, hodgkin@brandeis.edu, (2) Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, (3) Schneider Institute for Health Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA 02454, (4) Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 35,415 South St, Waltham, MA 02454

Important clinical advances in the pharmacologic treatment of addiction have been made recently. An important logistical development is that buprenorphine can be prescribed for drug-dependent individuals in an office-based setting. At the same time, many US health plans have implemented cost-sharing requirements and administrative controls to constrain their escalating medication costs. Such policies may impact alcohol and drug-dependent patients' use of these medications, that have demonstrated clinical and logistic advantages. These policies include formulary coverage exclusions, restrictions on first-line use, prior authorization requirements and placing medications on cost-sharing tiers with higher copayments. This study reports on the extent and stringency of private health plans' management of two medications for alcohol treatment (naltrexone, disulfiram), and three for opioid dependence (suboxone, subutex, LAAM). We surveyed commercial health plans in 60 US market areas regarding administrative and clinical aspects of behavioral health care delivery in 2003, yielding national estimates of plan features (N=368, response rate 83%). Thirty percent of plans excluded coverage for all three newer drugs for treating opioid dependence. Half of plans place these opioid medications on the highest cost-sharing tier, while 27% do so for disulfiram. Eleven percent of plans exclude generic naltrexone altogether. Disulfiram is the only medication for substance abuse that is both rarely excluded from coverage and usually placed on an intermediate cost-sharing tier. Plans are significantly more likely to employ either coverage exclusion or high cost-sharing tier placement for substance abuse medications than they are for antidepressants or antipsychotics.

Learning Objectives: Learning Objectives

At the conclusion of the session, participants will be able to
• Describe how US health plans’ efforts to constrain costs associated with substance abuse medications most commonly take the form of
  implementation of high cost-sharing and formulary coverage exclusions.
  • Summarize differences in the use of these mechanisms depending on whether the medication treats either alcohol or drug dependence.
  • Contrast the frequency with which plans exclude a substance abuse medication from formulary coverage altogether or place it on a high cost-sharing tier with that for antidepressants and antipsychotics.

  Keywords: Managed Care, Drugs

  Presenting author's disclosure statement:
  

  I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

  Substance Abuse Treatment Services Research and Descriptive Studies Poster Session

  The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA