# Insurance-related barriers to medications for opioid use disorder in private and Medicaid plans

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2022 · $676,084

## Abstract

PROJECT SUMMARY
In 2020, a record 71,000 opioid overdose deaths occurred in the U.S. The number of such deaths can be
reduced by buprenorphine, methadone, and extended-release naltrexone, the three FDA-approved
medications for opioid use disorder (MOUD). Despite this, many patients with opioid use disorder (OUD) never
initiate treatment with MOUD, and those that do often drop out of treatment, increasing their risk of death.
Although the uninsured are over-represented among patients with OUD, privately insured and Medicaid
patients represent three-quarters of non-elderly Americans with OUD, suggesting that mitigating barriers to
MOUD use in these patients is an especially important goal. Among the many such barriers, insurance-related
barriers are an appealing target for intervention, as insurance benefit design is directly under the control of
policymakers, insurers, and employers. However, the effects of insurance-related barriers on MOUD use in
privately insured and Medicaid patients have not been rigorously studied. Consequently, it is unclear which
barriers should be targeted in policy interventions and how these interventions should be designed. In this
proposal, we will provide actionable, policy-relevant information on the effect of cost-sharing for MOUD in
privately insured patients and on the effect of removing prior authorization requirements for MOUD in Medicaid
patients. To do so, we will analyze 2017-2023 data from several state-of-the-art national databases, including
prescription dispensing data from 92% of U.S. pharmacies, a pharmacy transactions database capturing 63%
of U.S. prescription volume, commercial claims from 55 million Americans, and 100% Medicaid claims from all
states. Analyses will focus on patients aged 15-64 years, an age group accounting for 96% of U.S. opioid
overdose deaths. In Aim 1, we will evaluate the association between cost-sharing and the risk of MOUD
prescription non-dispensing in privately insured patients, both overall and among key patient subgroups, such
as those initiating MOUD therapy. Additionally, we will use the commercial claims database to evaluate the
association between cost-sharing for MOUD and opioid overdose risk in privately insured patients. In Aim 2,
we will use difference-in-differences models, national pharmacy databases, and Medicaid claims to evaluate
whether state policies eliminating prior authorization requirements for MOUD in Medicaid plans were
associated with changes in MOUD dispensing, retention in MOUD therapy, and opioid overdose risk in
Medicaid patients. Findings from this proposal will inform and spur efforts to optimize insurance benefit design
for MOUD in private and Medicaid plans, potentially leading to the removal of insurance-related barriers that
may be contributing to rising opioid-related morbidity and mortality.

## Key facts

- **NIH application ID:** 10496824
- **Project number:** 1R01DA056438-01
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Kao-Ping Chua
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $676,084
- **Award type:** 1
- **Project period:** 2022-09-30 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10496824

## Citation

> US National Institutes of Health, RePORTER application 10496824, Insurance-related barriers to medications for opioid use disorder in private and Medicaid plans (1R01DA056438-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10496824. Licensed CC0.

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