Dispensing of medications used in MAT for Medicare Part D beneficiaries: Impact of 2016 CARA

Chris Gillette, PhD; Catherine Shull, PA-C, MPAS; Sarah J. Garvick, MS, MPAS, PA-C; Lindsey Mitchell, MSM, MMS, PA-C; Julienne Kirk, PharmD

doi:10.5055/jom.2021.0642

Authors

Chris Gillette, PhD https://orcid.org/0000-0002-8623-1285
Catherine Shull, PA-C, MPAS
Sarah J. Garvick, MS, MPAS, PA-C
Lindsey Mitchell, MSM, MMS, PA-C
Julienne Kirk, PharmD

DOI:

https://doi.org/10.5055/jom.2021.0642

Keywords:

medication-assisted therapy, Medicare, advanced practice provider

Abstract

Objectives: (1) To describe dispensing of FDA-approved medications used in medication-assisted treatment (MAT) in Medicare Part D beneficiaries during 2013-2017; (2) to identify yearly dispensing associated with physician assistants (PAs) and nurse practitioners (NPs) during 2013-2017; and (3) to examine how Comprehensive Addiction and Recovery Act (CARA) of 2016 impacted dispensing of medications used in MAT in 2016-2017.

Method: Retrospective secondary analysis of the Medicare Provider Utilization and Payment Data: Part D Prescriber datasets during the years 2013-2017. Generalized estimating equations (GEEs) were used to analyze the data.

Participants: Providers whose national provider identifier is associated with at least one FDA-approved medication used in MAT during 2013-2017 and paid for by Medicare Part D.

Main outcome measure: Per-prescriber population-adjusted number of claims for buprenorphine, buprenorphine/naloxone, and naltrexone.

Results: There were 4,657,233 claims for medications used in MAT from 2013 to 2017 (mean = 2,374.48 per 100,000). PAs and NPs combined for 254,543 claims during 2013-2017 (mean = 127.58 per 100,000). In the first full year after CARA, prescriptions for medications used in MAT by PAs and NPs increased a population-adjusted 46.96 percent. In the GEE regression model, there were significantly fewer per-provider claims in the years 2013-2015 (pre-CARA) compared with 2017 (post-CARA) (all p < 0.05).

Conclusion: The year after CARA was passed, claims for medications used in MAT from PAs and NPs increased.

Author Biographies

Chris Gillette, PhD

Associate Professor and Assistant Director of Scholarship and Research, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina

Catherine Shull, PA-C, MPAS

Assistant Professor, Department of PA Studies and Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

Sarah J. Garvick, MS, MPAS, PA-C

Assistant Professor, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina

Lindsey Mitchell, MSM, MMS, PA-C

Physician Assistant, Gammons Medical, Warren, Michigan

Julienne Kirk, PharmD

Professor, Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

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