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Insurance rules hamper treatment for opioid use disorder

Researchers say that rules make it difficult for some Medicare patients to obtain buprenorphine, a drug used to treat people with opioid dependence.

By Tauren Dyson

Feb. 13 (UPI) -- An effort to control costs in the insurance industry could be helping to fuel the nation's opioid epidemic, a new study says.

From 2007 to 2018, Medicare part D patient access to buprenorphine fell from 89 percent in 2007 to 35 percent in 2018, despite its effectiveness in treating opioid use disorder, according to a research letter published Tuesday in the Journal of the American Medical Association.

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In contrast, patients had a far easier path to opioids. During the same period, Medicare part D plan coverage of opioids jumped from 93 percent to 100 percent coverage, without restrictions, according to researchers.

"Buprenorphine is a safe and effective treatment that decreases deaths due to opioids and stops heroin and other opioid use. People on buprenorphine are able to get their lives back together," Todd Korthuis, a researcher at the Oregon Health & Science University School of Medicine and study co-author, said in a news release. "Medicare insurance companies are making it increasingly difficult to prescribe buprenorphine while making it easy to prescribe opioid pain medications that contributed to the opioid epidemic."

Buprenorphine removes pain and withdrawal symptoms associated by treating the same parts of the brain attacked opioids and heroin. The Food and Drug Administration approved buprenorphine for use in 2002, one of only three medicines approved to treat opioid dependence.

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The U.S. Substance Abuse and Mental Health Services even recommends buprenorphine to treat opioid dependence.

"Prior authorization policies are commonly used to control costs or manage pharmacy utilization, however they can also disrupt or delay treatment for individuals who are vulnerable to relapse," lead author Daniel Hartung, associate professor in the OHSU College of Pharmacy and study co-author, said in a news release. "Access to buprenorphine is vital within the Medicare program because Medicare has not historically covered methadone, which is the other opioid agonist indicated for opioid use disorder.

"Many people still believe that medication treatment isn't really recovery," Korthuis said. "Overwhelming scientific evidence supports that medicines like buprenorphine are far more successful and safer than abstinence-only approaches. Buprenorphine saves lives. Abstinence-based approaches don't."

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