Financial context of the adoption and use of medications to treat substance use disorders

BACKGROUND: Medications have the potential to significantly enhance the effectiveness of substance abuse treatment; however, their adoption into daily practice is influenced by a number of complex financial factors.

OBJECTIVE: To review trends in spending and utilization of substance abuse medications as well as the financial context that influences those trends.

METHODS: Data from several sources were reviewed to provide an overview of trends in financing for substance abuse medications. Data from IMS health and the SAMHSA Spending Estimates projects will be used to describe trends in spending and use of substance abuse medications. Data from recent surveys will be used to describe how substance abuse medications are positioned on private and public sector formularies. Data from interviews with third party payers will be used to describe barriers to utilization.

FINDINGS: Sales of substance abuse medications grew from $36 million to $406 million from 2006 to 2007. The majority of the increase stemmed from the introduction of buprenorphine. Spending on alcoholism medications also doubled as a result of the introduction of acamprosate. Nevertheless, substance abuse medication spending remained less than 1 to 2 percent of all substance abuse treatment spending in 2005. Information on how formularies are structured and where substance abuse medications fall on formularies will be presented. Several barriers may influence financial constraints on prescriptions including concerns about diversion, availability of generic alternatives, adverse selection, prices, return on investment, and stigma.