Price elasticity of demand for buprenorphine/naloxone prescriptions.

Although there have been supply-side efforts in response to the opioid crisis (e.g., prescription drug monitoring programs), little information exists on demand-side approaches related to patient cost sharing that may affect utilization of and adherence to pharmacotherapy by individuals with opioid use disorder. Among individuals who had initiated pharmacotherapy, we estimated the price elasticity of demand of prescription fills of buprenorphine/naloxone, a common pharmacotherapy drug, overall and by patient characteristics. Using the IBM MarketScan® Commercial Claims and Encounters Database for individuals with employer-sponsored private health insurance coverage, we examined the relationship between cost sharing and the number of buprenorphine/naloxone prescription fills using enrollee-level longitudinal fixed effects models. Cost sharing was expressed as a price index for each employer-plan. By including enrollee-level fixed effects, the identification of the effect of interest comes from longitudinal variation in prices across multiple time points for each enrollee. Overall, the demand for buprenorphine/naloxone was price inelastic (p = 0.191). However, some subgroups were responsive to price. A doubling of price was associated with a decrease in fills by 3.0% for enrollees aged 45-64 years (p = 0.029); 5.7% for those in rural areas (p = 0.033); 5.8% for residents of the South (p ≤0.001); and 3.0% for those enrolled in an HMO (p = 0.004). Insurers should consider the effects on these groups before increasing beneficiary out-of-pocket costs for pharmacotherapy and efforts to increase adherence should consider that price may be a barrier for some subgroups with OUD.

Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia.

OBJECTIVE: Primary care-based medical homes could improve the coordination of mental health care for individuals with schizophrenia and comorbid chronic conditions. The objective of this paper is to examine whether persons with schizophrenia and comorbid chronic conditions engage in primary care regularly, such that primary care settings have the potential to serve as a mental health home. METHOD: We examined the annual primary care and specialty mental health service utilization of adult North Carolina Medicaid enrollees with schizophrenia and at least one comorbid chronic condition who were in a medical home during 2007-2010. Using a fixed-effects regression approach, we also assessed the effect of medical home enrollment on utilization of primary care and specialty mental health care and medication adherence. RESULTS: A substantial majority (78.5%) of person-years had at least one primary care visit, and 17.9% had at least one primary care visit but no specialty mental health services use. Medical home enrollment was associated with increased use of primary care and specialty mental health care, as well as increased medication adherence. CONCLUSIONS: Medical home enrollees with schizophrenia and comorbid chronic conditions exhibited significant engagement in primary care, suggesting that primary-care-based medical homes could serve a care coordination function for persons with schizophrenia.

Effects of the 2013 Psychiatric Current Procedural Terminology Codes Revision on Psychotherapy in Psychiatric Billing.

OBJECTIVE: The purpose of this study was to determine whether the changes to the psychiatric Current Procedural Terminology (CPT) codes implemented in 2013 were associated with changes in types of services for which psychiatrists billed. METHODS: Analyses were conducted using paid private insurance claims from a large commercial database. The participant cohort comprised psychiatrists with at least one psychiatry visit reported in the database in each calendar year studied: 2012 (N of visits=778,445), 2013 (N=748,317), and 2014 (N=754,760). RESULTS: The percentage of visits in which psychiatrists billed for psychotherapy declined from 51.4% in 2012 to 42.1% in 2014. The decline held after the analyses adjusted for patient characteristics, plan type, and region. CONCLUSIONS: The update to CPT codes resulted in a decrease in visits for which psychiatrists billed for psychotherapy. Further research should explore whether the change in billing corresponds to changes in service delivery.

Do Medical Homes Offer Improved Diabetes Care for Medicaid Enrollees with Co-occurring Schizophrenia?

PURPOSE: To determine whether Medicaid recipients with co-occurring diabetes and schizophrenia that are medical-home-enrolled are more likely to receive guideline-concordant diabetes care than those who are not medical-home-enrolled, controlling for confounders. METHODS: We used administrative data on adult, non-dually eligible North Carolina Medicaid beneficiaries with diagnoses of both diabetes and schizophrenia (N= 3,897) for fiscal years 2008-2010. We evaluated the relationship between medical-home-enrollment and receipt of recommended diabetes care reimbursed by Medicaid (lipid profiles, HbA1c tests, medical attention for nephropathy, and eye exams for those over 30), using fixed-effects regression models on person-month level data. RESULTS: There was a statisti-cally significant, positive effect of medical home enrollment on receipt of Medicaid-funded eye exams, HbA1c tests, and medical attention for nephropathy, but not receipt of lipid profiles. CONCLUSIONS: For Medicaid enrollees with diabetes and schizophrenia, medical home enrollment is generally associated with greater likelihood of receiving guideline-concordant diabetes care.