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Title: Impact of high deductible health plans on continuous buprenorphine treatment for opioid use disorder Authors: Alene Kennedy-Hendricks, PhD,1,2 Cameron J. Schilling, MPH,1,2 Alisa B. Busch,3,4 MD, MS, Elizabeth A. Stuart, PhD,2,5 Haiden A. Huskamp, PhD,3 Mark K. Meiselbach, BS,1 Colleen L. Barry, PhD, MPP,1,2,5 Matthew Eisenberg, PhD1,2,6 1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 2 Johns Hopkins Center for Mental Health and Addiction Policy, Baltimore, MD 3 Department of Health Care Policy, Harvard Medical School, Boston, MA 4 McLean Hospital, Belmont, MA 5 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 6 OptumLabs Visiting Fellow, OptumLabs, Cambridge, MA Word Count: (300 word limit) Background/Objectives: Long-term, continuous treatment with medication like buprenorphine is the gold standard for opioid use disorder (OUD). As high deductible health plans (HDHP) become more prevalent in the commercial insurance market, they may pose financial barriers to people with OUD. This study sought to estimate the impact of HDHPs on continuity of buprenorphine treatment, concurrent visits for counseling/psychotherapy and OUD-related evaluation and management, and out-of-pocket spending. Methods: The analytic sample included enrollees with OUD from a national sample of commercial health insurance plans during 2007-2017 who initiated buprenorphine treatment. A difference-in-differences approach was used to compare trends in outcomes among enrollees whose employers offered an HDHP (treatment group) to enrollees whose employers never offered an HDHP (comparison group). Outcomes included: number of days of continuous buprenorphine treatment; probabilities of continuous buprenorphine treatment ≥30, ≥90, ≥180, and ≥365 days; probability of concurrent (i.e., within the same month) behavioral therapy (i.e., counseling or psychotherapy); probability of concurrent OUD-related evaluation and management visits; proportions of buprenorphine treatment episodes with counseling/psychotherapy and evaluation and management visits; and out-of-pocket (OOP) spending on buprenorphine, behavioral therapy, and evaluation and management visits. Results: HDHPs were associated with an average increase of $98 (95% CI: $48, $150) on OOP spending on buprenorphine per treatment episode but no change in the number of days of continuous buprenorphine treatment or concurrent use of related services. Conclusions: HDHPs do not reduce continuity of buprenorphine treatment among commercially insured enrollees with OUD but may increase financial burden for this population.
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