(207) Disenrollment Among Commercially-Insured Individuals in the United States with Opioid Use Disorder, 2010-2019

Background: Disenrollment from health insurance can be a significant barrier to care among beneficiaries seeking treatment for opioid use disorder (OUD).

Objectives: To characterize disenrollment patterns among commercially-insured beneficiaries with newly diagnosed OUD.

Methods: A retrospective cohort study of beneficiaries (18-85 years) who had an OUD diagnosis in the IBM MarketScan® commercial claims dataset from 2010-2019. Initial OUD treatment was measured in the three months after (treatment assignment period) the OUD diagnosis date (index date). Continuous enrollment was required in the six months before and three months after the index date. OUD treatment was defined as medications for OUD, alone and in combination with behavioral therapy, behavioral therapy alone, and no treatment. Beneficiaries were assigned to the following initial treatment categories: 1) no treatment, 2) behavioral treatment only, 3) buprenorphine only, 4) buprenorphine and behavioral treatment, 5) naltrexone only, 6) naltrexone and behavioral treatment, 7) methadone with or without behavioral treatment, and 8) other treatment combinations. Disenrollment was defined as the discontinuation of health insurance coverage and was measured as quarterly percentages in the twelve months after (follow-up period) the treatment assignment period.

Results: Our sample included 372,614 beneficiaries, of whom 134,221 (36.02%) were disenrolled in the follow-up period. Among 337,292 individuals receiving any treatment, 11.54% (n=38,946) were disenrolled during the first quarter of the follow-up period. Notably, a higher percentage of disenrollment was observed in the naltrexone only group during the first (219 [15.78%]) and second quarters (159 [11.46%]) compared to the other treatment groups. The proportion of disenrollment among those with no treatment in the first two quarters was comparable to disenrollment in the naltrexone only group; 5310 (15.03%) and 3805 (10.77%) during the first and second quarters, respectively. Disenrollment rates were consistently similar across all the groups in the third and fourth quarter of the follow-up period.

Conclusions: Higher disenrollment rates in the naltrexone only group, compared to other treatment groups, underscore the particular challenges to continuous health insurance enrollment in the naltrexone only group. However, disenrollment is a universally experienced issue in the OUD population. Further research to better understand underlying factors driving disenrollment, and thus potentially disruption of care, among those newly diagnosed with OUD should be undertaken.