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Use of Pharmacotherapy for Opioid Use Disorder

CBE ID
3400
Endorsement Status
E&M Committee Rationale/Justification

When the measure comes back for maintenance the developer should have:

  • Explored the impact of patients in remission or who are on other forms of treatment on the performance results; and
  • Assessed potential unintended consequences (e.g., discouraging use of other, non-pharmacological therapies) during implementation.
1.0 New or Maintenance
Previous Endorsement Cycle
Is Under Review
No
Next Maintenance Cycle
Spring 2029
1.6 Measure Description

The Use of Pharmacotherapy for Opioid Use Disorder measure evaluates the percentage of Medicaid or Medicare-Medicaid participants, aged 18 years and older, who have been diagnosed with an opioid use disorder (OUD) who filled a prescription for, were administered, or dispensed, a Food and Drug Administration (FDA)-approved medication to treat or manage OUD during the measurement year.

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
No
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.8a Population or Geographic Area Level of Analysis
State
1.10 Measure Rationale

Pharmacotherapy for OUD is related to improved health outcomes, therefore, a quality measure to increase access to pharmacotherapy is expected to yield better care for beneficiaries with an OUD.  Improved health outcomes associated with medications for OUD include reduced opioid use, overdose risk, and transmission of HIV and hepatitis C.

While other measures evaluate pharmacotherapy administration rates, CBE #3400 includes an analysis at the state-level and requires prescription fills within the measurement year. In addition, there are typically fewer quality measures for Medicaid and high rates of OUD for this population.

References:

Leshner, A., & Mancher, M. (2019). Medications for opioid use disorder save lives. National Academies Press.  https://doi.org/10.17226/25310.

1.20 Types of Data Sources
1.25 Data Source Details

CBE #3400 uses administrative claims or encounter data and pharmacy claims. For measure testing the data source is the Transformed Medicaid Statistical Information System (T-MSIS), which contains beneficiary, service utilization, administrative claims, and expenditure data for the Medicaid population, including those covered through both fee-for-service and managed care payers.