While opioids tend to cost very little, they lead to overutilization downstream, so patients with opioid use disorder should be treated in a comprehensive manner that includes behavioral health and social support, said Elizabeth Stringer, PhD, chief science and clinical officer of axialHealthcare.
Transcript
There are currently 3 FDA-approved opioid use disorder medications: methadone, buprenorphine, and naltrexone. Since adoption of these medications is low by treatment providers, reimbursement varies considerably among private and public payers. Given the variability among the medications, do your clients see these products as cost-effective?
One of the earliest challenges that we had at axial with helping the plans understand what were some of the large drivers and waste when it comes to medical healthcare utilization is around the pain and opioid space. Opioids are typically generic, and they cost the plans very little, but they lead to downstream overutilization, because it puts the patients at risk for emergency department [ED] visits, for inpatient hospital stays and ends up driving up care over time.
Very similarly, we are doing the same thing in the opioid use disorder space. Plans look at buprenorphine, suboxone, vivitrol as expensive treatments, particularly when that medication-assisted therapy, it’s not just the medication that might be expensive, it’s also that assisted part that behavioral health support and therapy, the case management and social support.
What we help the plans see is that when patients are treated in this comprehensive manner that addresses the biopsychosocial issues of opioid use disorder, that actually decreases cost, not only in the long run, but very much in the short run, as well. What happens is that when patients with opioid use disorder do not receive this comprehensive treatment, they’re rates of relapse skyrocket, and this leads to increase in ED and inpatient utilization at the hospital, which is completely unnecessary and can be mitigated when plans support and reimburse providers for that comprehensive patient treatment.
Via American Journal of Managed Care.
