Open Access Open Access  Restricted Access Subscription or Fee Access

Dispensing of medications used in MAT for Medicare Part D beneficiaries: Impact of 2016 CARA

Chris Gillette, PhD, Catherine Shull, PA-C, MPAS, Sarah J. Garvick, MS, MPAS, PA-C, Lindsey Mitchell, MSM, MMS, PA-C, Julienne Kirk, PharmD

Abstract


Objectives: (1) To describe dispensing of FDA-approved medications used in medication-assisted treatment (MAT) in Medicare Part D beneficiaries during 2013-2017; (2) to identify yearly dispensing associated with physician assistants (PAs) and nurse practitioners (NPs) during 2013-2017; and (3) to examine how Comprehensive Addiction and Recovery Act (CARA) of 2016 impacted dispensing of medications used in MAT in 2016-2017.

Method: Retrospective secondary analysis of the Medicare Provider Utilization and Payment Data: Part D Prescriber datasets during the years 2013-2017. Generalized estimating equations (GEEs) were used to analyze the data.

Participants: Providers whose national provider identifier is associated with at least one FDA-approved medication used in MAT during 2013-2017 and paid for by Medicare Part D.

Main outcome measure: Per-prescriber population-adjusted number of claims for buprenorphine, buprenorphine/naloxone, and naltrexone.

Results: There were 4,657,233 claims for medications used in MAT from 2013 to 2017 (mean = 2,374.48 per 100,000). PAs and NPs combined for 254,543 claims during 2013-2017 (mean = 127.58 per 100,000). In the first full year after CARA, prescriptions for medications used in MAT by PAs and NPs increased a population-adjusted 46.96 percent. In the GEE regression model, there were significantly fewer per-provider claims in the years 2013-2015 (pre-CARA) compared with 2017 (post-CARA) (all p < 0.05).

Conclusion: The year after CARA was passed, claims for medications used in MAT from PAs and NPs increased.


Keywords


medication-assisted therapy, Medicare, advanced practice provider

Full Text:

PDF

References


Centers for Disease Control and Prevention Website: Opioid overdose. 2020. Available at https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed April 20, 2020.

National Institute on Drug Abuse Website: Opioid overdose crisis. 2020. Available at https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis. Accessed April 20, 2020.

United States Department of Justice Website: DEA requirements for DATA waived physicians. Available at https://www.deadiversion.usdoj.gov/pubs/docs/dwp_buprenorphine.htm. Accessed April 20, 2020.

Eichel L, Pharis M: How medication-assisted treatment is used for opioid use disorder in Philadelphia: An approach called the ‘gold standard’ of care. Pew charitable trusts website. Available at https://www.pewtrusts.org/en/research-and-analysis/articles/2019/01/09/does-philadelphia-provide-enough-medication-assisted-treatment-for-opioid-use-disorder. Accessed March 16, 2020.

Stein BD, Pacula RL, Gordon AJ, et al.: Where is buprenorphine dispensed to treat opioid use disorders? The role of private offices, opioid treatment programs, and substance abuse treatment facilities in urban and rural counties. Milbank Q. 2015; 93(3): 561-583.

S.524-Comprehensive Addiction and Recovery Act of 2016: United States Congress website. Available at https://www.congress.gov/bill/114th-congress/senate-bill/524/text. Accessed April 20, 2020.

Barnett ML, Lee D, Frank RG: In rural areas, buprenorphine waiver adoption since 2017 driven by nurse practitioners and physician assistants. Health Aff. 2019; 38(12): 2048-2056.

Andrilla CHA, Jones KC, Patterson DG: Prescribing practices of nurse practitioners and physician assistants waivered to prescribe buprenorphine and the barriers they experience prescribing buprenorphine. J Rural Health. 2020; 36: 187-195.

Medicaid and CHIP Payment and Access Commission website: Buprenorphine prescribing by nurse practitioners, physician assistants and physicians after CARA 2016: Final research report. Available at https://www.macpac.gov/wp-content/uploads/2019/11/Buprenorphine-Prescribing-by-Nurse-Practitioners-Physician-Assistants-and-Physicians-after-CARA-2016.pdf. Accessed April 20, 2020.

Centers for Medicare and Medicaid Services Website: Medicare provider utilization and payment data: Part D prescriber. Available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Part-D-Prescriber. Accessed April 20, 2020.

Williams B, Mospan G, Seabock R, et al.: Emergency providers’ opioid prescribing behaviors among Medicare part D beneficiaries in North Carolina, 2013-2014: Medication utilization and costs. N C Med J. 2018; 79(3): 143-148.

Centers for Medicare and Medicaid Services Website: Medicare coverage of substance abuse services. 2016. Available at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1604.pdf. Accessed January 21, 2021.

CONSORT Website: The CONSORT diagram. Available at http://www.consort-statement.org/consort-statement/flow-diagram. Accessed April 20, 2020.

Census Regions and Divisions of the United States: United States Census Bureau website. Available at https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf. Accessed April 20, 2020.

Spetz J, Toretsky C, Chapman S, et al.: Nurse practitioner and physician assistant waivers to prescribe buprenorphine and state scope of practice restrictions. JAMA. 2019; 321(14): 1407-1408.

MAT Waiver Training Initiative: Physician Assistant Education Association website. Available at https://paeaonline.org/resources/public-resources/mat-waiver-training-initiative. Accessed April 7, 2021.

Andrilla CHA, Moore TE, Patterson DG, et al.: Geographic distribution of providers with a DEA waiver to prescribe buprenorphine for the treatment of opioid use disorder: A 5-year update. J Rural Health. 2019; 35(1): 108-112.

Centers for Disease Control and Prevention Website: Drug overdose mortality by state. 2020. Available at https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm. Accessed April 20, 2020.




DOI: https://doi.org/10.5055/jom.2021.0642

Refbacks

  • There are currently no refbacks.