Early Effects of COVID-19 on Programs Providing Medications for Opioid Use Disorder in Jails and Prisons.

OBJECTIVES: To describe how the novel coronavirus (COVID-19) pandemic has affected opioid agonist treatment (OAT) programs in jails and prisons. METHODS: In May 2020, we conducted an online survey of 19 carceral systems that provided methadone and/or buprenorphine treatment for incarcerated populations before COVID-19. Eleven survey items examined challenges and changes to these programs as a result of the pandemic. Sixteen of 19 programs (84%) responded to the survey. RESULTS: Ten out of 16 systems reported downsizing their OAT programs. Seven of 16 systems made changes to medication dispensation processes. Half of systems report challenges implementing physical distancing (n = 8), and/or obtaining personal protective equipment (n = 8). In 13 out of 16 systems some OAT program participants were released early due to COVID-19 infection risk. CONCLUSIONS: Jails and prisons with existing OAT programs have curtailed their operations in the context of the COVID-19 pandemic. Given the robust evidence base around OAT for treating opioid use disorder and averting overdose deaths, guidance is needed on maintaining and ramping up medication access as carceral facilities grapple with implementing COVID-19 mitigation.

Financial Risk for COVID-19-like Respiratory Hospitalizations in Consumer-Directed Health Plans.

INTRODUCTION: This study aims to quantify out-of-pocket spending associated with respiratory hospitalizations for conditions similar to those caused by coronavirus disease 2019 and to compare out-of-pocket spending differences among those enrolled in consumer-directed health plans and in traditional, low-deductible plans. METHODS: This study used deidentified administrative claims from the OptumLabs Data Warehouse (January 1, 2016-August 31, 2019) to identify patients with a respiratory hospitalization. It compared unadjusted out-of-pocket spending among consumer-directed health plan enrollees with that among traditional plan enrollees using difference of mean significance tests and repeated the analysis separately by age category and calendar year quarter. These data were collected on a rolling basis by OptumLabs and were analyzed in March 2020. RESULTS: Commercially insured consumer-directed health plan enrollees had significantly higher out-of-pocket spending than traditional plan enrollees, and these differences were largest among younger populations. The largest difference in out-of-pocket spending occurred during the first half of the year. CONCLUSIONS: Consumer-directed health plan enrollees may experience differential financial burden from a hospitalization related to coronavirus disease 2019. Although some insurers are waiving cost-sharing payments for coronavirus disease 2019 treatment, self-insured employers remain exempt. As of now, policy responses may be insufficient to reduce the financial burden on consumer-directed health plans enrollees with respiratory hospitalizations related to coronavirus disease 2019.