title: Health Insurance Enrollment and Availability of Medications for Substance Use Disorders.
abstract: Medications for treatment of substance use disorders are underutilized in treatment programs in the United States. Little is known about how insurance enrollment within states affects treatment program decisions about whether to offer medications. The primary objective of the study was to examine the impact of health insurance enrollment on availability of substance use disorder medications among treatment programs.
  
  
  
  Data from the 2012 National Survey of Substance Abuse Treatment Services, National Survey on Drug Use and Health, American Community Survey, Area Health Resource File, and the Substance Abuse and Mental Health Services Administration were combined to examine the impact of state insurance enrollment on availability of substance use disorder medications in treatment programs (N=9,888). A two-level, random-intercept logistic regression model was estimated to account for potential unobserved heterogeneity among treatment programs nested in states.
  
  
  
  The percentage of state residents with employer-based insurance and Medicaid was associated with greater odds of offering at least one medication among treatment programs. A 5% increase in the rate of private insurance enrollment was associated with a 7.7% increase in the probability of offering at least one medication, and a 5% increase in the rate of state Medicaid enrollment was associated with a 9.3% increase in the probability of offering at least one medication.
  
  
  
  Results point to the potential significance of health insurance enrollment in shaping the availability of substance use disorder medications. Significant expansions in health insurance enrollment spurred by the Affordable Care Act have the potential to increase access to medications for many Americans.
authors.affiliation: Dr. Abraham is with the Department of Public Administration and Policy and Dr. Jayawardhana is with the Department of Clinical and Administrative Pharmacy, University of Georgia, Athens (e-mail: aabraham@uga.edu ). Dr. Rieckmann is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Abraham
authors.affiliation: Dr. Abraham is with the Department of Public Administration and Policy and Dr. Jayawardhana is with the Department of Clinical and Administrative Pharmacy, University of Georgia, Athens (e-mail: aabraham@uga.edu ). Dr. Rieckmann is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia.
authors.forename: Traci
authors.initials: T
authors.lastname: Rieckmann
authors.affiliation: Dr. Abraham is with the Department of Public Administration and Policy and Dr. Jayawardhana is with the Department of Clinical and Administrative Pharmacy, University of Georgia, Athens (e-mail: aabraham@uga.edu ). Dr. Rieckmann is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Andrews
authors.affiliation: Dr. Abraham is with the Department of Public Administration and Policy and Dr. Jayawardhana is with the Department of Clinical and Administrative Pharmacy, University of Georgia, Athens (e-mail: aabraham@uga.edu ). Dr. Rieckmann is with the Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland. Dr. Andrews is with the College of Social Work, University of South Carolina, Columbia.
authors.forename: Jayani
authors.initials: J
authors.lastname: Jayawardhana
mesh_terms: D002491:Central Nervous System Agents / Q000627:therapeutic use*; D006264:Health Benefit Plans, Employee / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D002491:Central Nervous System Agents