Insurance Coverage Restrictions More Common for OUD Medications than Opioid Pain Medications

September 10, 2018

Across the United States, many die every day from an opioid overdose. Although opioid prescribing has recently decreased, rates remain three times higher than they were in 1999.

In a study in Medical Care, 30th Anniversary Professor of Health Care Policy Haiden Huskamp, PhD, health care policy research assistant Lauren Riedel, and colleagues compared coverage of drugs that treat opioid use disorder (OUD) to coverage of opioid pain medications by a sample of 100 plans offered on the 2017 Health Insurance Marketplaces. The OUD medications included buprenorphine/naloxone combination, buprenorphine, methadone, and naltrexone. The opioid pain medications included hydrocodone/acetaminophen, hydromorphone, oxycodone, oxycodone/acetaminophen, fentanyl, and morphine sulfate extended release, plus 5 abuse-deterrent formulations. 

After reviewing plan formularies, Huskamp and colleagues found that 14% of plans do not cover buprenorphine/naloxone, a preferred medication for OUD maintenance treatment. Only 11% of plans cover implantable buprenorphine and 26% cover injectable naltrexone, both of which may facilitate adherence for patients with OUD. Seventy-three percent of plans cover at least one abuse-deterrent opioid pain medication, while 100% of plans cover at least one short-acting opioid pain medication. Overall, many Marketplace plans do not cover OUD medications, or require prior authorization when covered. These coverage restrictions are often more common for OUD medications than opioid pain medications.

Huskamp’s study suggests that regulators of the Mental Health Parity and Addiction Equity Act focus on formulary coverage of drugs that treat OUD.