Medicaid Expansion Under the ACA Increased Access to Opioid Use Disorder Treatments

Expansion of Medicaid eligibility under the Affordable Care Act (ACA) enacted in 2014 and aimed to help low-income individuals obtain healthcare coverage was found to have resulted in increased access to opioid use disorder treatments for individuals with opioid medications covered by Medicaid, in a study published in JAMA Network Open.

In this cohort study, IQVIA pharmacy claims data from 11.9 million patients who filed ≥2 opioid prescriptions between 2010 and 2015 were analyzed. Prescriptions data were aggregated to county-year observations (n=2082) that were then linked to county-level covariates. Prescription changes prior to and after Medicaid expansion from counties in 5 states in which Medicaid expansion had or had not been enacted were analyzed.

From 2010 to 2015, the rate of individuals filling buprenorphine with naloxone prescriptions increased from 68.8 to 77.1 per 100,000 residents in “expansion” counties (difference-in-differences estimate, 8.7 per 100,000 residents; 95% CI, 1.7-15.7; P =.03), and from 98.8 to 99.2 per 100,000 residents in “non-expansion” counties.

The rate of individuals with prescriptions for opioid medications covered by Medicaid increased from 859.5 to 1170.9 per 100,000 residents in expansion counties and declined from 943.4 to 750.6 per 100,000 residents in non-expansion counties (difference between expansion and non-expansion counties, 374.0 per 100,000 residents; 95% CI, 258.3-489.7; P <.001). That rate declined in individuals covered by Medicare or private insurance in all counties examined. Prescription fills for opioids was comparable before and after Medicaid expansion in counties that had enforced it as well as in those that had not (difference-in-differences estimate, 327.4 per 100,000 residents; 95% CI -202.5 to 857.4; P =.16).

Limitations of the analysis were the inclusion of data from only 5 states and the lack of information on other variables that may have influenced prescription rates.

 “The increasing role of Medicaid in covering populations seeking treatments [for opioid use disorder] suggests the need for comprehensive efforts by state programs to track patients receiving [opioid pain relievers], expand nonopioid options for pain care, screen for opioid use disorder, and link high-risk patients to evidence-based addiction treatments, such as treatment with buprenorphine with naloxone.”

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Reference

Saloner B, Levin J, Chang H, Jones C, Alexander GC. Changes in buprenorphine-naloxone and opioid pain reliever prescriptions after the Affordable Care Act Medicaid expansion. JAMA Network Open. 2018;1(4):e181588.