Commercial Insurer Success in Increasing Adoption of Pharmacotherapy by Substance Use Disorder Treatment Programs

An estimated 13 million people in the US report non-medical use of prescription opioids in the previous year, of whom 2.5 million have opioid use disorders that require treatment. Only 10% of those with an opioid use disorder receive any type of specialty substance use treatment. Even fewer have access to pharmacotherapy including methadone maintenance, buprenorphine, or naltrexone, which have been proven to improve substance use outcomes. One study found that 56% of addiction treatment centers still do not prescribe evidence-based and cost-effective pharmacotherapy, despite evidence showing that those on medication for opioid use disorders have lower expenditures due to reduced use of emergency care and inpatient hospitalization.

In order to address the barriers to pharmacotherapy, the Advancing Recovery System Change model was developed to facilitate organizational change and promote the adoption of pharmacotherapy in publically funded substance use treatment facilities. Under the Advancing Recovery System Change model, the public funders worked with treatment providers to address several structural and organizational barriers that impeded access to pharmacotherapy.

In a recently published study, a team of researchers report on outcomes of the Medication Research Partnership (MRP) that was developed to adapt and test this model’s generalizability for a commercial health plan. The MRP was a collaboration between Aetna Behavioral Health and treatment centers contracting with Aetna on the Northeastern seaboard, including 8 short-term residential programs and one outpatient program. Over three years, intervention sites received training in the Advancing Recovery System Change model and identified structural and financial barriers to adoption of pharmacotherapies.

After adjusting for time trends using a “difference in difference” analysis, the researchers found the increase in prescriptions for pharmacotherapies for substance use disorders was higher by 12.5% among MRP sites than in the comparison sites that chose not to participate in the intervention. The greater gain in prescriptions at the MRP sites was significantly better for opioid use disorder patients but not alcohol use disorder patients, where similar improvements were observed at all sites. The findings support adaptation of the Advancing Recovery System Change model by commercial health plans, and evidence that these plans can have an influence on uptake of pharmacotherapy for opioid use disorder even if they do not account for the predominant share of a treatment program’s total revenue.

 

Dr. Hyong Un, MD, Chief Psychiatric Officer, Aetna Behavioral Health is a member of the CHERISH Policy Advisory Board

Mady Chalk, PhD, MSW, a co-author of this study, is also a member of the CHERISH Policy Advisory Board