Out-of-pocket Costs for Opioid Use Disorder Treatment Varied by Payer

Out-of-pocket costs for buprenorphine prescriptions for opioid use disorder treatment decreased between 2015 and 2020, but costs varied by payer, according to a study published in JAMA Network Open.

Consistent retention and adherence to buprenorphine, an FDA-approved medication for opioid use disorder (MOUD), has been associated with less opioid use and a 50 percent reduction in mortality risk. However, high out-of-pocket costs, limited clinician availability, and long wait times have led to low buprenorphine utilization.

Researchers used data from the IQVIA Longitudinal Prescription (LRx) database to determine how out-of-pocket costs for pharmacy-dispensed buprenorphine changed from 2015 to 2020 and how they varied by payer.

There were 7.3 million buprenorphine prescriptions dispensed in 2015 and 13.4 million dispensed in 2020. Private and commercial health plans paid for 26.99 percent of prescriptions in 2015, while Medicaid paid for 23.55 percent of prescriptions and Medicare paid for 5.91 percent.

In comparison, private and commercial payers paid for 20.57 percent of prescriptions in 2020, Medicaid paid for 43 percent, and Medicare paid for 10.16 percent.

In 2015, self-pay accounted for 11.52 percent of prescriptions, and assistance, including payments using a discount card, coupon, or voucher, accounted for 22.96 percent of prescriptions. In 2020, self-pay accounted for 6.39 percent of prescriptions, while assistance accounted for 12.17 percent.

The overall mean daily out-of-pocket cost for buprenorphine fell from $4.79 in 2015 to $1.91 in 2020, the study found. Medicaid had the lowest out-of-pocket costs throughout the study period, at $0.18 in 2015 and $0.10 in 2020.

The private and commercial plan mean cost fell significantly from $4.80 in 2015 to $1.82 in 2020 but remained higher than Medicaid and Medicare costs.

Self-pay and assistance had the highest out-of-pocket costs in both 2015 and 2020, the study noted. The self-pay mean cost went from $9.76 in 2015 to $8.44 in 2020, while the assistance cost fell from $8.72 to $6.31.

In 2020, private and commercial plans had the largest days supply for buprenorphine of 21.37 days, followed by Medicare with 20.60 days. Prescriptions paid by self-pay had a mean days supply of 12.62 days, while Medicaid prescriptions had a days supply of 15.59 days.

Buprenorphine prescriptions and out-of-pocket costs also varied by location. For example, the daily mean out-of-pocket cost was highest in the South at $2.91 and lowest in the Northeast at $1.04.

More than half of prescriptions paid for by self-pay and assistance were prescribed in the South. Similarly, the highest number of prescriptions paid for by private and commercial plans, Medicaid, and Medicare were prescribed in the South.

The highest number of prescriptions among all payers was prescribed in metropolitan counties. The mean daily out-of-pocket cost was also highest in metropolitan counties. Individuals between 35 and 44 years had the steepest mean out-of-pocket cost of $2.10 and received the most buprenorphine prescriptions.

“Public health and insurer strategies aimed at reducing higher patient out-of-pocket costs may address financial barriers and improve buprenorphine treatment retention,” researchers wrote. “Future research might continue to examine how cost-sharing may impact MOUD treatment initiation and retention under different payers.”

Recent data published in JAMA Network Open found that employer-sponsored health plans paid $35.3 billion to cover substance use disorder treatments in 2018.

According to industry experts, payers should use bundled payment plans, quality measures for substance use disorder co-occurring conditions, and harm reduction services benefits to improve coverage for substance use disorder treatments.