ImportanceIncreasing access to naloxone (an opioid antagonist that can reverse overdose) could slow the US opioid epidemic. Prior studies suggest cost sharing may be a barrier to dispensing of naloxone prescriptions, but these studies were limited by their cross-sectional designs and use of databases that do not capture prescriptions that are not filled (abandoned).ObjectiveTo evaluate the association between cost sharing and naloxone prescription abandonment (nondispensing of naloxone prescriptions).Design, Setting, and ParticipantsThis cross-sectional, regression discontinuity analysis exploited the fact that deductibles typically reset at the beginning of the year in commercial and Medicare plans. The included data were derived from the 2020-2021 IQVIA Formulary Impact Analyzer (a pharmacy transactions database that represents 63% of prescriptions at US pharmacies). The analysis included claims for naloxone nasal spray among commercially insured patients and Medicare patients that occurred during the 60 days before January 1, 2021, through 59 days after January 1, 2021.ExposureCost sharing, which is defined as the amount patients would have to pay to fill prescriptions.Main Outcomes and MeasuresLocal linear regression models were used to assess for abrupt changes in cost sharing and the probability of prescription abandonment on January 1, 2021. To estimate the association between cost sharing and prescription abandonment, a fuzzy regression discontinuity analysis was conducted.ResultsThese analyses included naloxone claims for 71 306 commercially insured patients and 101 706 Medicare patients (40 019 [56.1%] and 61 410 [60.4%], respectively, were female). The commercially insured patients and Medicare patients accounted for 73 311 and 106 076 naloxone claims, respectively. On January 1, 2021, the mean cost sharing per claim increased by $15.0 (95% CI, $13.8-$16.2) for commercially insured patients and increased by $12.3 (95% CI, $10.9-$13.6) for Medicare patients and the probability of abandonment increased by 4.7 (95% CI, 3.2-6.2) percentage points and 2.8 (95% CI, 1.6-4.1) percentage points, respectively. The results from the fuzzy regression discontinuity analysis suggest a decision by commercial and Medicare plans to increase naloxone cost sharing by $10 would be associated with percentage-point increases of 3.1 (95% CI, 2.2-4.1) and 2.3 (95% CI, 1.4-3.2), respectively, in the probability of abandonment.ConclusionsThe elimination of cost sharing might be associated with increased naloxone dispensing to commercially insured and Medicare patients.

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成本分摊与纳洛酮处方配药之间的关联


重要性增加纳洛酮（一种可以逆转用药过量的阿片类拮抗剂）的使用可能会减缓美国阿片类药物的流行。先前的研究表明，成本分摊可能是纳洛酮处方配发的障碍，但这些研究受到其横截面设计和使用的数据库的限制，这些数据库无法捕获未配药（废弃）的处方。 目的评估成本分摊之间的关联设计、设置和参与者这种横截面回归不连续性分析利用了商业和医疗保险计划中的免赔额通常在年初重置的事实。所包含的数据来自 2020-2021 年 IQVIA 处方影响分析器（一个药房交易数据库，代表美国药房 63% 的处方）。该分析包括商业保险患者和医疗保险患者在 2021 年 1 月 1 日之前 60 天内到 2021 年 1 月 1 日之后 59 天内发生的纳洛酮鼻喷雾剂索赔。暴露成本分摊，定义为患者必须支付的金额主要成果和措施使用局部线性回归模型来评估 2021 年 1 月 1 日费用分摊和处方放弃概率的突然变化。为了估计成本分摊和处方放弃之间的关联，我们进行了模糊回归不连续性分析结果这些分析包括 71 306 名商业保险患者和 101 706 名医疗保险患者的纳洛酮索赔（分别为 40 019 [56.1%] 和 61 410 [60.4%] 为女性）。 商业保险患者和医疗保险患者分别提出了 73 311 名纳洛酮索赔和 106 076 名纳洛酮索赔。 2021 年 1 月 1 日，商业保险患者每次索赔的平均分摊费用增加了 15.0 美元（95% CI，13.8-16.2 美元），医疗保险患者增加了 12.3 美元（95% CI，10.9-13.6 美元），并且放弃的可能性增加分别提高了 4.7 (95% CI, 3.2-6.2) 个百分点和 2.8 (95% CI, 1.6-4.1) 个百分点。模糊回归不连续性分析的结果表明，商业和医疗保险计划将纳洛酮费用分摊增加 10 美元的决定将与 3.1（95% CI，2.2-4.1）和 2.3（95% CI，1.4）的百分点增加相关。 -3.2)，分别是放弃的可能性。结论成本分摊的消除可能与商业保险和医疗保险患者的纳洛酮配药增加有关。