{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:55:28Z","timestamp":1781844928229,"version":"3.54.5"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,7,9]]},"abstract":"<jats:sec id=\"ab-joi240059-4\"><jats:title>Importance<\/jats:title><jats:p>Increasing access to naloxone (an opioid antagonist that can reverse overdose) could slow the US opioid epidemic. Prior studies suggest cost sharing may be a barrier to dispensing of naloxone prescriptions, but these studies were limited by their cross-sectional designs and use of databases that do not capture prescriptions that are not filled (abandoned).<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240059-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate the association between cost sharing and naloxone prescription abandonment (nondispensing of naloxone prescriptions).<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240059-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional, regression discontinuity analysis exploited the fact that deductibles typically reset at the beginning of the year in commercial and Medicare plans. The included data were derived from the 2020-2021 IQVIA Formulary Impact Analyzer (a pharmacy transactions database that represents 63% of prescriptions at US pharmacies). The analysis included claims for naloxone nasal spray among commercially insured patients and Medicare patients that occurred during the 60 days before January 1, 2021, through 59 days after January 1, 2021.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240059-7\"><jats:title>Exposure<\/jats:title><jats:p>Cost sharing, which is defined as the amount patients would have to pay to fill prescriptions.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240059-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Local linear regression models were used to assess for abrupt changes in cost sharing and the probability of prescription abandonment on January 1, 2021. To estimate the association between cost sharing and prescription abandonment, a fuzzy regression discontinuity analysis was conducted.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240059-9\"><jats:title>Results<\/jats:title><jats:p>These analyses included naloxone claims for 71\u202f306 commercially insured patients and 101\u202f706 Medicare patients (40\u202f019 [56.1%] and 61\u202f410 [60.4%], respectively, were female). The commercially insured patients and Medicare patients accounted for 73\u202f311 and 106\u202f076 naloxone claims, respectively. On January 1, 2021, the mean cost sharing per claim increased by $15.0 (95% CI, $13.8-$16.2) for commercially insured patients and increased by $12.3 (95% CI, $10.9-$13.6) for Medicare patients and the probability of abandonment increased by 4.7 (95% CI, 3.2-6.2) percentage points and 2.8 (95% CI, 1.6-4.1) percentage points, respectively. The results from the fuzzy regression discontinuity analysis suggest a decision by commercial and Medicare plans to increase naloxone cost sharing by $10 would be associated with percentage-point increases of 3.1 (95% CI, 2.2-4.1) and 2.3 (95% CI, 1.4-3.2), respectively, in the probability of abandonment.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi240059-10\"><jats:title>Conclusions<\/jats:title><jats:p>The elimination of cost sharing might be associated with increased naloxone dispensing to commercially insured and Medicare patients.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2024.8378","type":"journal-article","created":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T15:09:47Z","timestamp":1718291387000},"page":"124","source":"Crossref","is-referenced-by-count":15,"title":["Association Between Cost Sharing and Naloxone Prescription Dispensing"],"prefix":"10.1001","volume":"332","author":[{"given":"Kao-Ping","family":"Chua","sequence":"first","affiliation":[{"name":"Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor"},{"name":"Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rena M.","family":"Conti","sequence":"additional","affiliation":[{"name":"Department of Markets, Public Policy, and Law, Questrom School of Business, Boston University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Lagisetty","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy S.","family":"Bohnert","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijia","family":"He","sequence":"additional","affiliation":[{"name":"Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thuy D.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"4","key":"joi240059r6","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1111\/hesr.2019.54.issue-4","article-title":"Will converting naloxone to over-the-counter status increase pharmacy sales?","volume":"54","author":"Murphy","year":"2019","journal-title":"Health Serv Res"},{"key":"joi240059r7","doi-asserted-by":"publisher","DOI":"10.1177\/11782218221126972","article-title":"Associations between copays, coverage limits for naloxone, and prescribing in Medicaid.","volume":"16","author":"Messinger","year":"2022","journal-title":"Subst Abuse"},{"issue":"2","key":"joi240059r9","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1257\/jel.48.2.281","article-title":"Regression discontinuity designs in economics.","volume":"48","author":"Lee","year":"2010","journal-title":"J Econ Lit"},{"issue":"541","key":"joi240059r10","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1080\/01621459.2021.1923509","article-title":"Regression discontinuity designs with a continuous treatment.","volume":"118","author":"Dong","year":"2023","journal-title":"J Am Stat Assoc"},{"issue":"2","key":"joi240059r12","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1177\/1536867X1701700208","article-title":"rdrobust: software for regression-discontinuity designs.","volume":"17","author":"Calonico","year":"2017","journal-title":"Stata J"},{"issue":"2","key":"joi240059r13","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1093\/ectj\/utz022","article-title":"Optimal bandwidth choice for robust bias-corrected inference in regression discontinuity designs.","volume":"23","author":"Calonico","year":"2020","journal-title":"Econom J"},{"issue":"3","key":"joi240059r14","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1257\/pol.20160355","article-title":"Private provision of social insurance: drug-specific price elasticities and cost sharing in Medicare Part D.","volume":"10","author":"Einav","year":"2018","journal-title":"Am Econ J Econ Policy"},{"issue":"11","key":"joi240059r15","doi-asserted-by":"publisher","first-page":"1788","DOI":"10.1002\/hec.v27.11","article-title":"Price elasticities of pharmaceuticals in a value based-formulary setting.","volume":"27","author":"Yeung","year":"2018","journal-title":"Health Econ"},{"issue":"11","key":"joi240059r16","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1001\/jamacardio.2017.3451","article-title":"Association of prior authorization and out-of-pocket costs with patient access to PCSK9 inhibitor therapy.","volume":"2","author":"Navar","year":"2017","journal-title":"JAMA Cardiol"},{"issue":"5","key":"joi240059r17","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1200\/JCO.2017.74.5091","article-title":"Association of patient out-of-pocket costs with prescription abandonment and delay in fills of novel oral anticancer agents.","volume":"36","author":"Doshi","year":"2018","journal-title":"J Clin Oncol"},{"issue":"10","key":"joi240059r18","doi-asserted-by":"publisher","first-page":"633","DOI":"10.7326\/0003-4819-153-10-201011160-00005","article-title":"The epidemiology of prescriptions abandoned at the pharmacy.","volume":"153","author":"Shrank","year":"2010","journal-title":"Ann Intern Med"},{"issue":"10","key":"joi240059r20","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.3338","article-title":"Achieving the potential of naloxone saturation by measuring distribution.","volume":"4","author":"Sugarman","year":"2023","journal-title":"JAMA Health Forum"},{"issue":"1","key":"joi240059r21","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1186\/s12954-023-00891-x","article-title":"Racial\/ethnic differences in receipt of naloxone distributed by opioid overdose prevention programs in New York City.","volume":"20","author":"Nolen","year":"2023","journal-title":"Harm Reduct J"},{"issue":"3","key":"joi240059r22","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1080\/08897077.2017.1391924","article-title":"Barriers and facilitators to dispensing of intranasal naloxone by pharmacists.","volume":"39","author":"Bakhireva","year":"2018","journal-title":"Subst Abus"},{"issue":"8","key":"joi240059r23","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.7326\/M23-0852","article-title":"Moving naloxone over the counter is necessary but not sufficient.","volume":"176","author":"Messinger","year":"2023","journal-title":"Ann Intern Med"},{"key":"joi240059r1","unstructured":"US Centers for Disease Control and Prevention. National Vital Statistics System: provisional drug overdose death counts. Accessed October 1, 2023. https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug-overdose-data.htm"},{"key":"joi240059r2","unstructured":"US Department of Health and Human Services. US Surgeon General\u2019s advisory on naloxone and opioid overdose. Accessed October 1, 2023. https:\/\/www.hhs.gov\/surgeongeneral\/priorities\/opioids-and-addiction\/naloxone-advisory\/index.html"},{"key":"joi240059r3","unstructured":"Chandra? A, Flack? E, Obermeyer? Z. The health costs of cost-sharing: NBER working paper 28439. Accessed May 16, 2024. https:\/\/www.nber.org\/system\/files\/working_papers\/w28439\/w28439.pdf"},{"key":"joi240059r4","unstructured":"Beaton? T. Aetna to waive Narcan co-pays, combat opioid overprescribing. Accessed October 1, 2023. https:\/\/healthpayerintelligence.com\/news\/aetna-to-waive-narcan-co-pays-combat-opioid-overprescribing"},{"key":"joi240059r5","unstructured":"United Healthcare. UnitedHealthcare to eliminate out-of-pocket costs on several prescription drugs, including insulin, for eligible members. Accessed October 1, 2023. https:\/\/newsroom.uhc.com\/news-releases\/uhc-eliminate-out-of-pocket-costs.html"},{"key":"joi240059r8","unstructured":"Equator Network. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Accessed March 5, 2019. https:\/\/www.equator-network.org\/reporting-guidelines\/strobe\/"},{"key":"joi240059r11","unstructured":"US Food and Drug Administration. FDA announces shelf-life extension for naloxone nasal spray. Accessed February 11, 2024. https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-announces-shelf-life-extension-naloxone-nasal-spray"},{"key":"joi240059r19","unstructured":"IQVIA Institute. The use of medicines in the US 2023: usage and spending trends and outlook to 2027. 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