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Stucchi, Andrea

University of British Columbia

Background – Opioid Agonist Therapy (OAT) is considered the most effective form of pharmacological treatment for opioid use disorder (OUD). Previously, OAT medications were publicly subsidized in British Columbia by two PharmaCare plans: Fair PharmaCare, a voluntary, income-based plan providing partial coverage through a mix of deductible and co-payments; and the Income Assistance plan, offering full coverage of designated medications to registrants of social assistance. In response to the on-going opioid crisis, on February 1, 2017, BC added methadone and buprenorphine/naloxone used for OAT to a third plan – the Psychiatric Medications plan (Plan G), thereby expanding full coverage to an additional plan. Methods – Using administrative data, this thesis aimed to determine the impact of greater public coverage for OAT medications on BC residents living with OUD, with regard to utilization of, and retention in OAT, and the public and private financial consequences thereof, through an interrupted time series analysis (ITS) with control design. Use of the policy, and factors associated with its beneficiaries were similarly investigated, using ITS and logistic regression, respectively. Results – The addition of OAT medications to Plan G resulted in an increase in plan enrollments amongst BC residents previously subject to out-of-pocket costs for treatment. Results also suggest utilization and retention for buprenorphine/naloxone treatment increased. Methadone users benefitted from a small decrease in out-of-pocket expenses, while results for buprenorphine/naloxone were rendered inconclusive due to coinciding events. The removal of cost-sharing for non-OAT medications under Plan G resulted in an increase in PharmaCare expenditures, suggesting beneficiaries of the policy change also utilized other psychiatric medications available on the plan. Conclusion – The addition of OAT medications to Plan G was effective at providing greater drug coverage for a subset of BC’s population that was previously underserved by the PharmaCare system. Given the complexity of OUD, increases in utilization and retention for buprenorphine/naloxone treatment are encouraging. A reduction in client-costs for methadone should similarly be considered a success. With BC continuing to report record numbers of opioid-related deaths, the necessity of the income requirement for Plan G enrollment should be reconsidered if the goal is to reach the widest possible population.

Text

2022-09-30

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/80101

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/