title: The impact of prior authorization on buprenorphine dose, relapse rates, and cost for Massachusetts Medicaid beneficiaries with opioid dependence.
abstract: OBJECTIVE
  To assess the impact of a 2008 dose-based prior authorization policy for Massachusetts Medicaid beneficiaries using buprenorphine + naloxone for opioid addiction treatment. Doses higher than 16 mg required progressively more frequent authorizations.
  
  
  METHODS
  Mediciaid claims for 2007 and 2008 linked with Department of Public Health (DPH) service records.
  
  
  METHODS
  We conducted time series for all buprenorphine users and a longitudinal cohort analysis of 2,049 individuals who began buprenorphine treatment in 2007. Outcome measures included use of relapse-related services, health care expenditures per person, and buprenorphine expenditures.
  
  
  METHODS
  We used ICD-9 codes and National Drug Codes to identify individuals with opioid dependence who filled prescriptions for buprenorphine. Medicaid and DPH data were linked with individual identifiers.
  
  
  RESULTS
  Individuals using doses >24 mg decreased from 16.5 to 4.1 percent. Relapses increased temporarily for some users but returned to previous levels within 3 months. Buprenorphine expenditures decreased but total expenditures did not change significantly.
  
  
  CONCLUSIONS
  Prior authorization policies strategically targeted by dose level appear to successfully reduce use of higher than recommended buprenorphine doses. Savings from these policies are modest and may be accompanied by brief increases in relapse rates. Lower doses may decrease diversion of buprenorphine.
authors.affiliation: Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA.
authors.forename: Robin E
authors.initials: RE
authors.lastname: Clark
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Baxter
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Barton
authors.forename: Gideon
authors.initials: G
authors.lastname: Aweh
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Connell
authors.forename: William H
authors.initials: WH
authors.lastname: Fisher
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000191:economics*; D002047:Buprenorphine / Q000008:administration & dosage* / Q000191:economics*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004335:Drug and Narcotic Control; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008404:Massachusetts; D008484:Medicaid / Q000191:economics*; D058850:Opiate Substitution Treatment / Q000191:economics*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000191:economics*; D012008:Recurrence; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine
keywords: Drug addiction treatment; Medicaid; buprenorphine; pharmaceutical policy; prior authorization