title: Availability of addiction medications in private health plans.
abstract: Health plans have implemented cost sharing and administrative controls to constrain escalating prescription expenditures. These policies may impact physicians' prescribing and patients' use of these medications. Important clinical advances in the pharmacological treatment of addiction highlight the need to examine how pharmacy benefits consider medications for substance dependence. The extent of restrictions influencing the availability of these medications to consumers is unknown. We use nationally representative survey data to examine the extent and stringency of private health plans' management of naltrexone and disulfiram for alcohol dependence, and buprenorphine for opiate dependence. Thirty-one percent of insurance products excluded buprenorphine from formularies, whereas 55% placed it on the highest cost-sharing tier. Generic naltrexone is the only substance dependence medication that is both rarely excluded from formularies and usually placed on a lower cost-sharing tier. These findings demonstrate that pharmacy benefits have an impact on access to medications for substance abuse.
authors.affiliation: Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, USA. horgan@brandeis.edu
authors.forename: Constance M
authors.initials: CM
authors.lastname: Horgan
authors.forename: Sharon
authors.initials: S
authors.lastname: Reif
authors.forename: Dominic
authors.initials: D
authors.lastname: Hodgkin
authors.forename: Deborah W
authors.initials: DW
authors.lastname: Garnick
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Merrick
mesh_terms: D000427:Alcohol Deterrents / Q000191:economics / Q000627:therapeutic use; D000437:Alcoholism / Q000188:drug therapy; D002047:Buprenorphine / Q000191:economics / Q000627:therapeutic use; D017047:Cost Sharing; D003625:Data Collection; D004221:Disulfiram / Q000191:economics / Q000627:therapeutic use; D016568:Drugs, Generic / Q000191:economics; D005569:Formularies as Topic; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data*; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data*; D009271:Naltrexone / Q000191:economics / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000191:economics / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy; D014481:United States
chemical_list: D000427:Alcohol Deterrents; D016568:Drugs, Generic; D009292:Narcotic Antagonists; D002047:Buprenorphine; D009271:Naltrexone; D004221:Disulfiram