# Impact of Medicaid Prescription Cap Policies on Treatment Outcomes for Opioid Use Disorder: A National Mixed Methods Study

> **NIH NIH R01** · BROWN UNIVERSITY · 2024 · $752,432

## Abstract

PROJECT SUMMARY
More than 2 million people have opioid use disorder (OUD) in the U.S. and opioids accounted for 70% of the
nearly 100,000 drug-overdose deaths in 2020. Increasing OUD prevalence and opioid-involved overdose deaths
underscore the urgent need for improved access to effective OUD treatments. Methadone, buprenorphine, and
naltrexone are effective in treating OUD, yet these medications for OUD (MOUD) are underutilized, particularly
among low-income Medicaid beneficiaries who represent a sizable portion of the U.S. population living with OUD.
Prescription (Rx) caps represent a cost-containment strategy employed by some state Medicaid programs that
limit the number of brand name drugs or total number of prescriptions that may be filled each month. Rx cap
policies potentially exacerbate the opioid epidemic by impeding access to MOUD among financially constrained
Medicaid beneficiaries, many of whom have comorbid chronic health conditions (e.g., mental illness, chronic
pain, HIV), and who are forced to make tradeoffs between which medically necessary medications to fill. Though
a few older studies have used Medicaid data to evaluate the impact of Rx caps on the health of the general
population, until now, this has not been studied among people with OUD – an NIH priority population. The
objective of this application is to examine whether and how Medicaid Rx caps affect the care and health of people
with OUD and other chronic health conditions. Our long-term research goal is to develop an evidence base that
can be used to revise medication utilization management policies in ways that balance budget priorities with
improved patient and population health outcomes. Our central hypothesis is that Rx caps contribute to reduced
uptake of and continuity with MOUD treatment, resulting in increased overdoses and mortality. The rationale for
this hypothesis is that people with OUD frequently have co-occurring conditions and are likely to require several
simultaneous prescriptions to manage their health, placing them at risk for exceeding the caps. Our skilled team
of health services researchers, pharmacists, clinicians, and epidemiologists has extensive experience using
Medicaid claims data and qualitative methods to study the impact of health policies on marginalized populations.
We propose to analyze national Medicaid data to evaluate the impact of Rx cap policies on initiation and
continuity of MOUD use among individuals diagnosed with OUD; and determine the impact of Rx cap policies
on health services utilization, overdoses, and all-cause mortality among this population. We will then
contextualize our quantitative findings via interviews with patients with OUD and providers who practice in states
impacted by cap policies to elucidate their experiences with caps and identify best practices for navigating these
policies. Completion of this research will help to close critical knowledge gaps by generating novel mixed-method
findings on Rx drug covera...

## Key facts

- **NIH application ID:** 10813166
- **Project number:** 5R01DA057979-02
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Patience Moyo Dow
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $752,432
- **Award type:** 5
- **Project period:** 2023-04-01 → 2028-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10813166

## Citation

> US National Institutes of Health, RePORTER application 10813166, Impact of Medicaid Prescription Cap Policies on Treatment Outcomes for Opioid Use Disorder: A National Mixed Methods Study (5R01DA057979-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10813166. Licensed CC0.

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