Insurance Discrimination When Paying for Suboxone Treatment

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Tina and Melinda are both addicted to opioids. Both of these women are paying for suboxone treatment for their opioid use disorder.

Tina has private insurance. Melinda has Medicaid coverage.

Which of these two women is more likely to get an appointment? Will providers discriminate when it comes to the method for paying for suboxone treatment?

That’s what researchers wanted to find out. So, they used “secret shoppers” to get answers.

Investigators from Baylor University’s Hankamer School of Business, RAND Corporation, and Vanderbilt University Medical Center’s Departments of Pediatrics and Health Policy collaborated on the study.

Here’s what they discovered.

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It’s Hard for Anyone to Get an Appointment

Researchers made 3,420 simulated patient calls for the study. The callers identified themselves as women with Medicaid coverage or private insurance coverage. All were requesting appointments with buprenorphine providers.

Guess how many successfully landed an insurance-covered appointment? Less than half. Even with Medicaid or private insurance.

Only 45 percent of women with private insurance coverage were able to get an appointment. And just 38 percent of women with Medicaid insurance were as well.

According to the study’s lead author Michael Richards, MD, PhD, MPH, and associate professor at Baylor University in Waco:

The most striking finding is — for both callers that had private insurance and callers that had Medicaid — just how infrequently they’re able to actually leverage those insurance benefits when it comes to getting an appointment for opioid use disorder. That really speaks to the many serious and substantive access hurdles these individuals have to clear.

It’s Harder for Medicaid Patients…in Certain Areas

Previous research has shown significant differences in access to opioid use disorder treatment between patients with Medicaid versus private insurance. And this study was no different.

However, researchers discovered that these results varied based on one key factor.

Researchers found that callers with Medicaid were 11 percent less likely to get an appointment if Medicaid coverage was not common in the surrounding community.

But, as the percentage of Medicaid coverage in the local community went up, so did the number of Medicaid patients getting appointments.

In areas where Medicaid coverage was prevalent enough, the difference in access to care was insignificant.

Causes of Discrimination in Paying for Suboxone Treatment 

Investigators can’t say for sure what is causing this disparity. They suspect it might be as simple as paperwork issues.

According to the study findings, providers in areas with a higher rate of Medicaid coverage may be more familiar with business processes needed to obtain payment from Medicaid for buprenorphine treatment.

But the problem is most likely multifaceted, they admit.

Whatever the issues are, researchers suggest that these findings guide future efforts. They advise, “Efforts to improve access to treatment may be best targeted to areas where Medicaid prevalence is lower.”

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MAT Numbers Remain Low

In 2020, nearly 70,000 people in the United States died from opioid overdoses. Currently, buprenorphine is one of three medication-assisted treatments (MAT) approved by the World Health Organization and the FDA to treat opioid use disorder. This medication can help diminish withdrawal symptoms and cravings.

This, in turn, lowers the potential for opioid misuse.

The number of clinicians who can prescribe buprenorphine has increased 300 percent. But less than 33 percent of individuals with opioid use disorder receive any kind of MAT. Researchers hope their efforts can make a change in these numbers.

“Making it through the structural barriers to just getting into treatment for opioid use disorder is extraordinarily hard, even if you’re the most motivated person on the planet,” says study principal investigator Stephen Patrick, MD, MPH. He’s from the department of health policy at Vanderbilt University Medical Center in Nashville, Tennessee.

“We are seeing record-setting rates of overdose death, and for every overdose death, there are a slew of other hospitalizations and additional family members affected. I hope our continued research garners the attention of the public and policymakers and more clearly communicates that we must put solutions in place to break down these barriers.”

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the Take-Away

Tina and Melinda are both addicted to opioids. Both of these women are paying for suboxone treatment for their opioid use disorder. Tina has private insurance. Melinda has Medicaid coverage. Which of these two women is more likely to get an appointment? Will providers discriminate when it comes to the method for paying for suboxone …