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Rx Summit Spotlight: Researchers Bring Clarity to Coverage of OUD Treatment

April 12, 2019

When it comes to insurance coverage for the treatment of opioid use disorder, the landscape these days is changing dramatically. Understanding exactly how coverage is changing, how those changes are being implemented, and the implications of that evolution for patients and providers alike is an ongoing challenge.

To address it, researchers at Shatterproof, the not-for-profit addiction treatment advocacy group, and the University of Pennsylvania’s Leonard Davis Institute of Health Economics recently set out to develop an in-depth system for tracking insurance coverage for OUD across the nation.

Caroline Davidson, MPH, a research associate at Shatterproof, and Amanda Mauri, MPH, a graduate student in the Health Services Organization and Policy Program at the University of Michigan who works with Shatterproof in a consulting role, each took part in this six-month research project. They’ll present their findings at the Rx Drug Abuse & Heroin Summit, which will be held this month in Atlanta. Recently, they spoke with Behavioral Healthcare Executive to preview their presentation.

What were your goals and what were you looking to identify with this research project?

Caroline: When we first started the project, we knew there was this existence of tracking of what sort of coverage there was for opioid use disorder treatment, focusing particularly on medication-assisted treatment for OUD—methadone, buprenorphine and naltrexone. We knew there was a broad assessment of this coverage, but there was no assessment at the plan level. When we began the project, that was our theme: We wanted to understand at the plan level, literally for every single plan within a given payer purview, what does that coverage look like and what are the restrictions on that coverage? In particular, we wanted to say can we make an instrument that allows us to track this coverage nationally for both private and public payers, and if we can, can we develop a system that allows us to track it over time?

We want to understand what coverage policies are out there so that we can work with payers to shift those in the right direction of covering these services. Payment is a large barrier to people accessing OUD treatment.

Amanda: When we were thinking about payment originally, it was in a very broad sense. It’s payment in terms of reimbursement, but also payment practices such as utilization management techniques—both quantitative and qualitative. That became more narrowed as the project went along.

Was there a particular finding in your research that jumped out at you?

Amanda: As the project went along, instead of focusing broadly on this overall idea of payment for medication-assisted treatment, we focused on alternative payment models. How payers were moving away from fee-for-service toward different strategies for reimbursement. We ended up focusing even more narrowly on bundled payments. One of the main findings we learned was, number one, payers are really excited about the idea of moving toward alternative payment models, specifically, bundled payments for medication-assisted treatment.

They already have some in place, and we are going to walk through those in detail, but we’re also going to talk about where payers seem to be moving forward with this in the future, meaning what are their strategies for expanding bundled payments in terms of population and targeted services.

The Rx Drug Abuse & Heroin Summit, April 22-25 in Atlanta, is where solutions are formulated, stakeholders from Federal to family convene, and change begins. It is the annual gathering for stakeholders to discuss what's working in prevention and treatment. For more information, visit rx-summit.com

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