Abstract：
BACKGROUND: The national opioid crisis continues to intensify, despite the fact that opioid use disorder (OUD) is treatable and opioid overdose deaths are preventable through first-line treatment with medications for opioid use disorder (MOUD). This study identifies and categorizes payment-related barriers that impact MOUD access and retention from both the provider and patient perspectives and provides insight into how these barriers can be addressed.
METHODS: We performed a critical review of the literature (peer-reviewed studies and relevant documents from the gray literature) to identify payment-related access and retention barriers to MOUD. We used the results of this review to develop an analytic framework to understand how payment impacts MOUD access and retention for both providers and patients. In addition, we reviewed action plans developed by Massachusetts communities that participated in the Healing Communities Study (HCS) to analyze which payment-related barriers were addressed through the study.
RESULTS: We identified 18 payment-related barriers that patients or providers face when initiating or continuing MOUD with either methadone or buprenorphine in Opioid Treatment Programs (OTP) and non-OTP settings. Patient-related barriers mainly relate to health insurance coverage or the design of health plans (e.g., cost sharing, covered benefits) resulting in direct (medical and non-medical) and indirect costs that can affect both access and retention, especially as they relate to services provided in OTPs. Provider-related barriers include low reimbursement and administrative burden and are most likely to impact access to MOUD. Evidence-based strategies to expand MOUD as part of the HCS in Massachusetts targeted about half of the patient and provider payment-related barriers identified.
CONCLUSIONS: Patients and providers face an array of payment-related barriers that impact access to and retention on MOUD, most of which relate to inadequate health insurance coverage, features of health plans, and key federal and state policies. As new regulatory policies are enacted that expand access to MOUD, such as greater flexibility in OTPs and MOUD delivered via telehealth, it will be important to align these delivery changes with payment reform involving payers, providers, and policymakers.
METHODS: We performed a critical review of the literature (peer-reviewed studies and relevant documents from the gray literature) to identify payment-related access and retention barriers to MOUD. We used the results of this review to develop an analytic framework to understand how payment impacts MOUD access and retention for both providers and patients. In addition, we reviewed action plans developed by Massachusetts communities that participated in the Healing Communities Study (HCS) to analyze which payment-related barriers were addressed through the study.
RESULTS: We identified 18 payment-related barriers that patients or providers face when initiating or continuing MOUD with either methadone or buprenorphine in Opioid Treatment Programs (OTP) and non-OTP settings. Patient-related barriers mainly relate to health insurance coverage or the design of health plans (e.g., cost sharing, covered benefits) resulting in direct (medical and non-medical) and indirect costs that can affect both access and retention, especially as they relate to services provided in OTPs. Provider-related barriers include low reimbursement and administrative burden and are most likely to impact access to MOUD. Evidence-based strategies to expand MOUD as part of the HCS in Massachusetts targeted about half of the patient and provider payment-related barriers identified.
CONCLUSIONS: Patients and providers face an array of payment-related barriers that impact access to and retention on MOUD, most of which relate to inadequate health insurance coverage, features of health plans, and key federal and state policies. As new regulatory policies are enacted that expand access to MOUD, such as greater flexibility in OTPs and MOUD delivered via telehealth, it will be important to align these delivery changes with payment reform involving payers, providers, and policymakers.
摘要：
背景：全国阿片类药物危机继续加剧，尽管阿片类药物使用障碍（OUD）是可以治疗的，并且阿片类药物过量死亡可以通过阿片类药物使用障碍（MOUD）的一线治疗来预防。这项研究从提供者和患者的角度识别并分类了影响MOUD访问和保留的与支付相关的障碍，并提供了如何解决这些障碍的见解。
方法：我们对文献（同行评审研究和灰色文献中的相关文件）进行了严格审查，以确定与支付相关的MOUD访问和保留障碍。我们使用这篇综述的结果来开发一个分析框架，以了解支付如何影响提供商和患者的MOUD访问和保留。此外,我们回顾了参与治疗社区研究(HCS)的马萨诸塞州社区制定的行动计划,以分析通过该研究解决了哪些与支付相关的障碍.
结果：我们确定了患者或提供者在阿片类药物治疗计划（OTP）和非OTP设置中开始或继续使用美沙酮或丁丙诺啡进行MOUD时面临的18个支付相关障碍。与患者相关的障碍主要涉及健康保险范围或健康计划的设计(例如，费用分摊,承保福利)导致可能影响获取和保留的直接(医疗和非医疗)和间接成本，特别是它们与OTP中提供的服务有关。与提供商相关的障碍包括低报销和行政负担，并且最有可能影响使用MOUD。作为马萨诸塞州HCS的一部分，扩大MOUD的循证策略针对大约一半的患者和提供者支付相关的障碍。
结论：患者和提供者面临一系列与支付相关的障碍，这些障碍会影响MOUD的获取和保留，其中大部分与医疗保险覆盖面不足有关，健康计划的特点，以及关键的联邦和州政策。随着新的监管政策的颁布，扩大了对MOUD的访问，例如通过远程医疗提供的OTP和MOUD的更大灵活性，重要的是要使这些交付变化与涉及付款人的支付改革保持一致，提供者,和政策制定者。
方法：我们对文献（同行评审研究和灰色文献中的相关文件）进行了严格审查，以确定与支付相关的MOUD访问和保留障碍。我们使用这篇综述的结果来开发一个分析框架，以了解支付如何影响提供商和患者的MOUD访问和保留。此外,我们回顾了参与治疗社区研究(HCS)的马萨诸塞州社区制定的行动计划,以分析通过该研究解决了哪些与支付相关的障碍.
结果：我们确定了患者或提供者在阿片类药物治疗计划（OTP）和非OTP设置中开始或继续使用美沙酮或丁丙诺啡进行MOUD时面临的18个支付相关障碍。与患者相关的障碍主要涉及健康保险范围或健康计划的设计(例如，费用分摊,承保福利)导致可能影响获取和保留的直接(医疗和非医疗)和间接成本，特别是它们与OTP中提供的服务有关。与提供商相关的障碍包括低报销和行政负担，并且最有可能影响使用MOUD。作为马萨诸塞州HCS的一部分，扩大MOUD的循证策略针对大约一半的患者和提供者支付相关的障碍。
结论：患者和提供者面临一系列与支付相关的障碍，这些障碍会影响MOUD的获取和保留，其中大部分与医疗保险覆盖面不足有关，健康计划的特点，以及关键的联邦和州政策。随着新的监管政策的颁布，扩大了对MOUD的访问，例如通过远程医疗提供的OTP和MOUD的更大灵活性，重要的是要使这些交付变化与涉及付款人的支付改革保持一致，提供者,和政策制定者。
