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Access to addiction pharmacotherapy in private U.S. health plans
Abstracts / Drug and Alcohol Dependence 140 (2014) e86–e168
Results: After 26 weeks, 73%, 77%, and 85% of participants in the Usual Care, Methadone, and Methadone & Abstinence Groups, respectively, were enrolled in methadone treatment. Methadone & Abstinence participants provided significantly more urine samples negative for opiates (73%) and cocaine (61%) than Usual Care participants (43% and 23%, respectively), and significantly more urine samples negative for opiates than Methadone participants (49%). Methadone participants provided significantly more urine samples negative for cocaine (44%) than Usual Care participants. Conclusions: Although most participants enrolled in methadone treatment, many continued to use opiates and cocaine. Employment-based abstinence reinforcement in the therapeutic workplace was critical in promoting abstinence from opiates and cocaine. Financial support: R01DA023864, K24DA023186, and T32DA07209. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.263 Access to addiction pharmacotherapy in private U.S. health plans Constance M. Horgan, S. Reif, Deborah W. Garnick, D. Hodgkin, M. Stewart, E. Merrick, A. Quinn Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States Aims: Medication-based approaches to addiction treatment are a widely endorsed evidence-based practice. An increasing number of medications now are available to treat alcohol and opiate addictions. To understand access to these medications, it is essential to consider the role private health plans may exert through benefit design. Health plans often use cost-sharing and administrative controls, which may impact physicians’ prescribing and patients’ use of addiction medications. A decade ago, coverage exclusions and assignment to the highest cost-sharing tier were common for buprenorphine, the newest addiction medication at the time. This study explores health plans’ current approaches to benefit design affecting addiction medications. Methods: Data are from a nationally representative telephone survey of private US health plans in 2010 (n = 385, response rate: 89%). We examined plans’ management of naltrexone, extendedrelease naltrexone, acamprosate, and suboxone and techniques to encourage use of addiction pharmacotherapy. Results are weighted and represent national estimates. Results: 96% of products covered extended-release naltrexone, and of those, 50% considered it part of the medical benefit rather than the pharmacy benefit. Other addiction medications were commonly covered (acamprosate 91%, naltrexone 99% and suboxone 100%). Prior authorization was common for only for extended-release naltrexone and rare for other medications. Extended-release naltrexone and acamprosate were usually on the most expensive payment tier in terms of patient cost sharing. Health plans used a variety of ways to encourage addiction pharmacotherapy including provider feedback, financial incentives, coverage and consumer cost-sharing mechanisms. Conclusions: Management techniques and placement on higher cost-sharing tiers were common and may lead to restricted access to effective treatment options for addiction. Financial support: Grants from the National Institute on Alcohol Abuse and Alcoholism (R01 AA010869) and the National Institute on Drug Abuse (R01 DA029316). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.264
e91
Long-term effects of brief strategic family therapy for adolescent substance users Viviana E. Horigian 1 , D.J. Feaster 1 , M.S. Robbins 2,1 , A. Brincks 1 , M.A. Perez 1 , J. Szapocznik 1 1
University of Miami, Miami, FL, United States Oregon Research Institute, Eugene, OR, United States 2
Aims: Emerging adulthood, a stage of development from age 18 to 26, is characterized by rapid transitions into new social contexts that involve greater freedom and less social control than experienced during adolescence. This period of development is important because it is characterized by peak prevalence of substance abuse problem and sets a stage for later adult development. To examine the long term effectiveness of Brief Strategic Family Therapy® (BSFT® ) compared to Treatment As Usual (TAU) in the rates of substance use, number of arrests and externalizing behaviors. To determine if the two interventions, delivered to youth at the time when they were adolescents, differentially influenced outcomes during emerging adulthood. Design: 379 of 480 adolescents that participated in the BSFT effectiveness study agreed to be contacted for extended follow ups. Adolescents in the BSFT effectiveness study were randomized to BSFT or TAU. Methods: One-time assessment of Drug Use, Externalizing behaviors, Arrests and incarcerations was conducted using Timeline Follow Back, Adult Self Report and self report respectively. The average number of years between randomization in the original study and the follow-up study was 4.69 (SD = 0.74; range = 3–7 years). Drug Use, Arrests and incarcerations were examined using negative binomial models and externalizing was examined using linear regression. Results: BSFT youth had lower incidence arrests and of lifetime incarcerations as compared to youth assigned to TAU (B = −0.33, p = .01; IRR = 0.72, 95% confidence interval: 0.55, 0.93) and (B = −0.42, p = .04; IRR = 0.66, 95% confidence interval: 0.44, 0.98) respectively. BSFT significantly predicted externalizing at follow-up (B = −0.41, p < .05), but was not related to drug use. Conclusions: BSFT may have sleeper effects in reducing the number of arrests and externalizing problems. Financial support: This work was supported by ARRA grant number RC2 DA028864-02. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.265 Research issues in executive functioning: Implications for addictions treatment Arthur M. Horton Neuropsychology Section, Psych Associates of Maryland, Bethesda, MD, United States Aims: Recent research has postulated that the crucial elements in executive functioning are monitoring and updating short-term memory, inhabitation of prepotent responses and task-shifting. This poster will discuss research issue proposing a neural network model of executive functioning. Methods: Past theories related to executive functioning, have focused on frontal lobe functioning to an excessive degree. This poster will discuss research problems and strategies for elucidating executive functioning. In addition, multiple interacting neuroanatomical areas are postulated to sub serve executive functioning skills and will need to be delineated.
Results: After 26 weeks, 73%, 77%, and 85% of participants in the Usual Care, Methadone, and Methadone & Abstinence Groups, respectively, were enrolled in methadone treatment. Methadone & Abstinence participants provided significantly more urine samples negative for opiates (73%) and cocaine (61%) than Usual Care participants (43% and 23%, respectively), and significantly more urine samples negative for opiates than Methadone participants (49%). Methadone participants provided significantly more urine samples negative for cocaine (44%) than Usual Care participants. Conclusions: Although most participants enrolled in methadone treatment, many continued to use opiates and cocaine. Employment-based abstinence reinforcement in the therapeutic workplace was critical in promoting abstinence from opiates and cocaine. Financial support: R01DA023864, K24DA023186, and T32DA07209. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.263 Access to addiction pharmacotherapy in private U.S. health plans Constance M. Horgan, S. Reif, Deborah W. Garnick, D. Hodgkin, M. Stewart, E. Merrick, A. Quinn Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States Aims: Medication-based approaches to addiction treatment are a widely endorsed evidence-based practice. An increasing number of medications now are available to treat alcohol and opiate addictions. To understand access to these medications, it is essential to consider the role private health plans may exert through benefit design. Health plans often use cost-sharing and administrative controls, which may impact physicians’ prescribing and patients’ use of addiction medications. A decade ago, coverage exclusions and assignment to the highest cost-sharing tier were common for buprenorphine, the newest addiction medication at the time. This study explores health plans’ current approaches to benefit design affecting addiction medications. Methods: Data are from a nationally representative telephone survey of private US health plans in 2010 (n = 385, response rate: 89%). We examined plans’ management of naltrexone, extendedrelease naltrexone, acamprosate, and suboxone and techniques to encourage use of addiction pharmacotherapy. Results are weighted and represent national estimates. Results: 96% of products covered extended-release naltrexone, and of those, 50% considered it part of the medical benefit rather than the pharmacy benefit. Other addiction medications were commonly covered (acamprosate 91%, naltrexone 99% and suboxone 100%). Prior authorization was common for only for extended-release naltrexone and rare for other medications. Extended-release naltrexone and acamprosate were usually on the most expensive payment tier in terms of patient cost sharing. Health plans used a variety of ways to encourage addiction pharmacotherapy including provider feedback, financial incentives, coverage and consumer cost-sharing mechanisms. Conclusions: Management techniques and placement on higher cost-sharing tiers were common and may lead to restricted access to effective treatment options for addiction. Financial support: Grants from the National Institute on Alcohol Abuse and Alcoholism (R01 AA010869) and the National Institute on Drug Abuse (R01 DA029316). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.264
e91
Long-term effects of brief strategic family therapy for adolescent substance users Viviana E. Horigian 1 , D.J. Feaster 1 , M.S. Robbins 2,1 , A. Brincks 1 , M.A. Perez 1 , J. Szapocznik 1 1
University of Miami, Miami, FL, United States Oregon Research Institute, Eugene, OR, United States 2
Aims: Emerging adulthood, a stage of development from age 18 to 26, is characterized by rapid transitions into new social contexts that involve greater freedom and less social control than experienced during adolescence. This period of development is important because it is characterized by peak prevalence of substance abuse problem and sets a stage for later adult development. To examine the long term effectiveness of Brief Strategic Family Therapy® (BSFT® ) compared to Treatment As Usual (TAU) in the rates of substance use, number of arrests and externalizing behaviors. To determine if the two interventions, delivered to youth at the time when they were adolescents, differentially influenced outcomes during emerging adulthood. Design: 379 of 480 adolescents that participated in the BSFT effectiveness study agreed to be contacted for extended follow ups. Adolescents in the BSFT effectiveness study were randomized to BSFT or TAU. Methods: One-time assessment of Drug Use, Externalizing behaviors, Arrests and incarcerations was conducted using Timeline Follow Back, Adult Self Report and self report respectively. The average number of years between randomization in the original study and the follow-up study was 4.69 (SD = 0.74; range = 3–7 years). Drug Use, Arrests and incarcerations were examined using negative binomial models and externalizing was examined using linear regression. Results: BSFT youth had lower incidence arrests and of lifetime incarcerations as compared to youth assigned to TAU (B = −0.33, p = .01; IRR = 0.72, 95% confidence interval: 0.55, 0.93) and (B = −0.42, p = .04; IRR = 0.66, 95% confidence interval: 0.44, 0.98) respectively. BSFT significantly predicted externalizing at follow-up (B = −0.41, p < .05), but was not related to drug use. Conclusions: BSFT may have sleeper effects in reducing the number of arrests and externalizing problems. Financial support: This work was supported by ARRA grant number RC2 DA028864-02. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.265 Research issues in executive functioning: Implications for addictions treatment Arthur M. Horton Neuropsychology Section, Psych Associates of Maryland, Bethesda, MD, United States Aims: Recent research has postulated that the crucial elements in executive functioning are monitoring and updating short-term memory, inhabitation of prepotent responses and task-shifting. This poster will discuss research issue proposing a neural network model of executive functioning. Methods: Past theories related to executive functioning, have focused on frontal lobe functioning to an excessive degree. This poster will discuss research problems and strategies for elucidating executive functioning. In addition, multiple interacting neuroanatomical areas are postulated to sub serve executive functioning skills and will need to be delineated.