Medicaid prescription cap policies and acute care use and mortality among enrollees with opioid use disorder.

Background: Twelve state Medicaid programs limit the monthly number of covered prescriptions. Such cap policies may force enrollees to forego essential medications with important health consequences. We aimed to determine the impact of cap policies on acute care use and all-cause mortality among enrollees with opioid use disorder (OUD).

Cardiovascular Health at the Intersection of Race and Gender in Medicare Fee for Service.

Importance: Transgender and gender diverse (TGD) people have significantly higher rates of cardiovascular-related conditions than cisgender people, and Black and Hispanic people have higher rates of cardiovascular-related conditions than non-Hispanic White people. However, little is known about the prevalence of cardiovascular-related conditions among racial and ethnic subgroups of TGD people.

Objective: To compare the prevalence of cardiovascular-related conditions across racial and ethnic groups for TGD and cisgender people using quantitative intersectional methods.

Understanding Provider Treatment Approaches for the Provision of Gender-Affirming Hormones in the Current US Political Climate.

Transgender people's access to gender-affirming hormone therapy (GAHT) is under attack in the United States. In 2024, we interviewed US providers about how they prescribe GAHT. In accordance with informed consent models, providers reported that they reviewed patients' medical history, social supports, and comorbidities; prescribed GAHT formulations that aligned with patients' goals; monitored health regularly; and maintained open communication with patients.

Impact of a Pharmacy Copayment Increase on Medication Use in the Military Health System.

Background: We analyzed the impact of a copayment increase instituted February 1, 2018 for persons covered by the retail or mail order Military Health System (MHS) pharmacy benefit.

Methods: We compared medication use in 2 cohorts in the 12 months before and after the copayment increase: MHS beneficiaries between 18 and 64 years old (MHS cohort), and MHS beneficiaries older than or equal to 65 years old with Medicare (Medicare cohort). Subjects with diabetes, hypertension and hypercholesterolemia were eligible.

Coverage Gaps and Contraceptive Use Among Medicare Enrollees With Disabilities.

Importance: Medicare is the primary health insurance payer for 1.5 million reproductive-aged women with disabilities, yet it is the only major form of US health insurance that is not required to cover contraceptives for pregnancy prevention.

Objective: To evaluate whether Medicare's contraceptive coverage gaps were associated with reduced use of contraceptives by enrollees with disabilities.

Association of state medicaid prescription cap policies with trajectories of buprenorphine use for opioid use disorder.

Background: Buprenorphine and other medications for opioid use disorder (OUD) can reduce opioid-related morbidity and mortality. It is unknown whether state Medicaid prescription cap policies that restrict the monthly number of covered prescription fills affect the duration of buprenorphine use.

Objective: To identify trajectories of buprenorphine use and determine the association of caps with trajectory group membership among individuals with OUD.

Trends and Disparities in the Use of Opioid, Gabapentinoid, and Nonpharmacologic Pain Therapies Among Medicare Beneficiaries With Acute Low Back Pain, 2016-2019.

Contemporary practice guidelines recommend nonpharmacologic therapies instead of prescription opioids as first-line treatment for many pain types, including acute low back pain (aLBP). This serial cross-sectional study describes trends in the annual prevalence of physical therapy (PT), chiropractic care, gabapentinoids, and prescription opioid receipt among Medicare beneficiaries diagnosed with aLBP from 2016 to 2019, overall and within key demographic, clinical, and geographic subgroups. Overall, changes in PT (5.

Gender-Affirming Surgery for Transgender and Gender Diverse Medicare Beneficiaries.

Importance: Medicare covers gender-affirming surgical procedures on a case-by-case basis. The proportion of Medicare beneficiaries who receive gender-affirming surgical procedures is unknown.

Objective: To examine the frequency and trends of gender-affirming surgical procedures for Medicare beneficiaries.

Association of Pharmacologic and Nonpharmacologic Management of Acute Low Back Pain with Overdose Hospitalizations: A Nested Case-Control Study.

Noninvasive nonpharmacologic therapies are recommended for managing acute low back pain (aLBP) and have the potential to mitigate opioid-related harms. However, little is known about whether incorporating nonpharmacologic therapies into aLBP management affects adverse outcomes. The objective was to determine if receiving nonpharmacologic pain therapies, alone or combined with pharmacologic options, is associated with drug-related overdose hospitalizations among Medicare beneficiaries with aLBP.

Effects of Visitation Restriction on Antipsychotic Drug Use among Nursing Home Residents with ADRD during the COVID-19 Pandemic.

Objectives: To estimate the immediate and long-term effects of a visitor restriction policy on antipsychotic use in nursing home (NH) residents with Alzheimer's disease and related dementias (ADRD) during COVID-19.

Design: A repeated cross-sectional study time series analysis was conducted using NH electronic health records (EHRs) from January 1, 2020, to December 31, 2021.

Setting And Participants: A large, multistate sample of NH residents living with ADRD.

Characterizing disparities in the HIV care continuum among U.S. transgender and cisgender Medicare beneficiaries, 2008-2017.

Although HIV is more prevalent among transgender and gender-diverse individuals than cisgender people, a dearth of research has compared the HIV-related care engagement of these populations. Using 2008-2017 Medicare data, we identified TGD (trans feminine and non-binary [TFN], trans masculine and non-binary [TMN], unclassified gender) and cisgender (male, female) beneficiaries with HIV and explored within and between gender group differences in the predicted probability of engagement in the HIV Care Continuum. Transgender and gender-diverse individuals had a higher predicted probability of every HIV-related care outcome vs.

Effects of Nursing Home Changes in Antipsychotic Use on Outcomes among Residents with Dementia.

Objectives: Little information exists on whether nationwide efforts to reduce antipsychotic use among nursing home (NH) residents with Alzheimer's disease and related dementias improved mortality and hospitalization outcomes for residents. Our objective was to examine the effect of NH decreases in antipsychotic use on outcomes for residents with Alzheimer's disease and related dementias.

Design: Observational nationwide study that emulated a series of cluster randomized trials.

Chronic conditions among transgender Medicare beneficiaries: Variation by race, ethnicity, and Medicaid dual-enrollment.

Background: Transgender and gender diverse (TGD) adults experience disability at twice the rate of cisgender (non-TGD) adults in the US. TGD people of color and low-income TGD people experience intersecting discrimination that may compound chronic conditions and disability. To our knowledge, no research has focused on chronic conditions among TGD Medicare beneficiaries with disabilities.

Does cancer clinical trial enrollment for sexual and gender minority people differ from heterosexual, cisgender people?

Background: Sexual and gender minority (SGM) people experience cancer disparities compared to heterosexual and cisgender (non-SGM) people and likely have barriers to cancer clinical trial enrollment. Data are sparse, however, regarding cancer clinical trial enrollment for SGM versus non-SGM people.

Methods: Using data from the 2020 Behavioral Risk Factor Surveillance Survey (BRFSS), we applied a logistic regression to assess associations between SGM status and clinical trial enrollment for 346 SGM and 9441 non-SGM people diagnosed with cancer.

Association of nursing home antipsychotic reduction policies with antipsychotic use in community dwellers with dementia.

Background: Antipsychotic and other psychotropic medication use is prevalent among community-dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care ("the Partnership") and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.

Impact of federal antipsychotic use policy in nursing homes on new diagnoses for approved indications in dementia residents.

Background: Federal policies targeting antipsychotic use among nursing home (NH) residents may have increased reporting of diagnoses for approved uses, including schizophrenia, Tourette's syndrome, and Huntington's Disease (called "exclusionary diagnoses" because they exclude residents from the antipsychotic quality metric). We assessed changes in new exclusionary diagnoses among long-stay NH admissions specifically with dementia following federal policies.

Methods: Retrospective, quarterly, interrupted time-series analysis (2009-2018) of new long-stay NH residents with dementia and no exclusionary diagnoses reported before NH admission.

Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis.

Background: Practice guidelines recommend nonpharmacologic and nonopioid therapies as first-line pain treatment for acute pain. However, little is known about their utilization generally and among individuals with opioid use disorder (OUD) for whom opioid and other pharmacologic therapies carry greater risk of harm.

Objective: To determine the association between a pre-existing OUD diagnosis and treatment of acute low back pain (aLBP).

Characterizing Disparities in the HIV Care Continuum among Transgender and Cisgender Medicare Beneficiaries.

Background: In the US, transgender and gender-diverse (TGD) individuals, particularly trans feminine individuals, experience a disproportionately high burden of HIV relative to their cisgender counterparts. While engagement in the HIV Care Continuum (e.g.

The relationship of age and comorbid conditions to hospital and nursing home days in Medicaid recipients with HIV.

Objective: To determine how aging impacts healthcare utilization in persons with HIV (PWH) compared with persons without HIV (PWoH).

Design: Matched case-control study.

Methods: We studied Medicaid recipients in the United States, aged 18-64 years, from 2001 to 2012.

Contraceptive Use Among Traditional Medicare And Medicare Advantage Enrollees.

Medicare is the primary source of health insurance coverage for reproductive-age people with Social Security Disability Insurance. However, Medicare does not require contraceptive coverage for pregnancy prevention, and little is known about contraceptive use in traditional Medicare and Medicare Advantage. We analyzed Medicare and Optum data to assess variations in contraceptive use and methods used by traditional Medicare and Medicare Advantage enrollees, as well as among enrollees with and without noncontraceptive clinical indications.

Treatment Patterns and Population Characteristics of Nonpharmacological Management of Chronic Pain in the United States' Medicare Population: A Scoping Review.

Background And Objectives: Clinical practice guidelines recommend noninvasive nonpharmacological pain therapies; however, reviews that assess the literature pertaining to nonpharmacological pain management among older adults and people with long-term disabilities who are disproportionately affected by pain are lacking. This scoping review aimed to systematically map and characterize the existing studies about the receipt of noninvasive, nonpharmacological pain therapies by Medicare beneficiaries.

Research Design And Methods: We conducted a literature search in MEDLINE (PubMed), CINAHL (EBSCO), SocINDEX (EBSCO), Cochrane Library, Web of Science citation indices, and various sources of gray literature.

Association of Opioid Use Disorder Diagnosis With Use of Physical Therapy and Chiropractic Care Among Chronic Low Back Pain Patients: A Group-Based Trajectory Analysis.

Nonpharmacologic approaches are recommended as first-line treatment for chronic pain, and their importance is heightened among individuals with co-occurring opioid use disorder (OUD), in whom opioid therapies may be particularly detrimental. Our objectives were to assess the receipt and trajectories of nonpharmacologic pain treatment and determine the association of OUD diagnosis with these trajectories. This retrospective cohort study used Medicare claims data from 2016 to 2018 and applied group-based trajectory models to identify distinct patterns of physical therapy (PT) or chiropractic care treatment over the 12 months following a new episode of chronic low back pain.