OBJECTIVES : To assess pharmacotherapy underutilization for opioid use disorder (OUD), the National Committee for Quality Assurance proposed a measure identifying new medication-assisted treatment (MAT) episodes and assessing treatment adherence. This measure calculates the percentage of new OUD pharmacotherapy episodes resulting in at least 180 covered treatment days over a 365-day period. This study aims to utilize and interpret the proposed measure.

METHODS : In IBM MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases, patients with OUD diagnoses between January 1, 2012 and December 31, 2017 were selected. MAT-dispensing events were identified, where patients did not have active MAT prescriptions during 15 days prior to initial dispensing event. Patients were minimum age 16 and continuously enrolled for 15 days prior to, and 180 days following, initial MAT. Separately for Commercial and Medicare enrollees, medication possession ratios (MPRs) were calculated within 365 days following initial MAT, and the proportions of patients with MPRs of at least 50% were captured.

RESULTS : This study includes 61,921 MAT-treated Commercial patients (63% male, 100% under age 65, 38% from South), and 942 Medicare patients (58% male, 33% under age 65, 22% from South). Among Commercial and Medicare patients, 46% (n=28,751) and 40% (n=379) had MPRs of at least 50%, respectively. Among 631 Medicare patients aged at least 65, 44% (n=275) had an MPR of at least 50%. Among 311 Medicare patients under age 65, 33% (n=104) had an MPR of at least 50%.

CONCLUSIONS : This HEDIS® measure implementation confirms its feasibility using real-world data and identifies gaps in care, with less than half of patients having MPRs of at least 50% within the first year of treatment, and young (<65 years old) Medicare patients having particularly low MPRs. To improve engagement in care, research should utilize this measure to identify factors associated with low MAT coverage.