Medications for opioid use disorder can be life-saving for the more than two million Americans struggling with opioid addiction. However, cost can be a major barrier to accessing these medications, especially for those relying on Medicaid coverage.
As of November 2021, ten states have implemented Medicaid cap policies that limit the number of covered prescriptions in an effort to control spending: Alabama, Arkansas, Illinois, Kansas, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and Texas. These policies can restrict access to essential care and increase hospitalizations and mortality. Texas Medicaid, for instance, limits its beneficiaries to three prescription fills per month, which can be problematic for those who need more, forcing them to choose between paying out of pocket or forgoing some treatments altogether.
Jaclyn White Hughto, assistant professor of behavioral and social sciences and of epidemiology, has been awarded over $3.5M from the NIH’s National Institute on Drug Abuse to study the impact of these spending caps. The grant spans five years and is aimed at investigating the impact of Medicaid cap policies on access to and utilization of Medication for Opioid Use Disorder (MOUD) and associated outcomes, such as overdose among Medicaid beneficiaries with opioid use disorder and other chronic health conditions.
By analyzing Medicaid claims data and conducting interviews with patients and providers, Hughto and Patience Moyo, co-principal investigator of the study and assistant professor of health services, policy and practice, hope to identify best practices for navigating these policies and ultimately improve patient and population health. Their findings will be especially important for vulnerable populations who rely on public assistance to access medications for chronic conditions.
We spoke with Professor Hughto about her team’s project, “Impact of Medicaid Prescription Cap Policies on Treatment Outcomes for Opioid Use Disorder: A National Mixed-Methods Study.”
Tell us the significance of this study and how it might inform policy decisions related to opioid treatment?
We aim to study how “cap policies” affect people with Opioid Use Disorder (OUD) who rely on Medicaid. By analyzing Medicaid claims data and talking to patients and providers, we hope to identify the best ways to navigate these policies and improve access to treatment.
If successful, the research could lead to policy changes that improve health outcomes and save lives among individuals with OUD who are subject to Medicaid cap policies. By demonstrating the impact of cap policies on the opioid and overdose crisis, our work could inform efforts to reduce structural barriers to life-saving medications and treatment, in turn helping people with OUD to access MOUD, reduce their use of illicit opioids, and ultimately, decrease the number of overdose deaths.
Your research often centers around the impact of stigma on the health of marginalized populations. Will your team integrate this perspective into the current project? And what are some of the potential implications for addressing stigma within opioid treatment?
We are using a mixed-methods approach that includes analyzing Medicaid claims data and conducting interviews with prescribers, pharmacists, and people with OUD. We want to identify the different forms of stigma that may impact access to treatment, both at the interpersonal and individual levels.
By understanding the role of stigma in medication access, we can make recommendations to reduce stigma and improve access to treatment for all people with OUD, regardless of whether they are subject to Medicaid cap policies.
How do you envision your study contributing to the broader efforts to address the overdose crisis?
Much of the current opioid and overdose crisis is driven by the widespread availability of illicitly-manufactured fentanyl in the drug supply. Research shows that people who are on MOUD and are exposed to fentanyl are at reduced risk of fatal fentanyl–involved overdoses. Thus, increasing access to medication is essential to help reduce the harms of fentanyl exposure and help people meet their recovery goals.
One way to do this is to understand how existing policies shape access to care. If these policies result in adverse health outcomes, we can use this information to educate policymakers on the importance of modifying these policies to improve access.