The DOI matches its Crossref record; 43 of the 45 references it cites were found in a registry or an index.
Payment-related barriers to medications for opioid use disorder: A critical review of the literature and real-world application
Open accessAbstract
BACKGROUND: The national opioid crisis continues to intensify, despite the fact that opioid use disorder (OUD) is treatable and opioid overdose deaths are preventable through first-line treatment with medications for opioid use disorder (MOUD). This study identifies and categorizes payment-related barriers that impact MOUD access and retention from both the provider and patient perspectives and provides insight into how these barriers can be addressed. METHODS: We performed a critical review of the literature (peer-reviewed studies and relevant documents from the gray literature) to identify payment-related access and retention barriers to MOUD. We used the results of this review to develop an analytic framework to understand how payment impacts MOUD access and retention for both providers and patients. In addition, we reviewed action plans developed by Massachusetts communities that participated in the Healing Communities Study (HCS) to analyze which payment-related barriers were addressed through the study. RESULTS: We identified 18 payment-related barriers that patients or providers face when initiating or continuing MOUD with either methadone or buprenorphine in Opioid Treatment Programs (OTP) and non-OTP settings. Patient-related barriers mainly relate to health insurance coverage or the design of health plans (e.g., cost sharing, covered benefits) resulting in direct (medical and non-medical) and indirect costs that can affect both access and retention, especially as they relate to services provided in OTPs. Provider-related barriers include low reimbursement and administrative burden and are most likely to impact access to MOUD. Evidence-based strategies to expand MOUD as part of the HCS in Massachusetts targeted about half of the patient and provider payment-related barriers identified. CONCLUSION: Patients and providers face an array of payment-related barriers that impact access to and retention on MOUD, most of which relate to inadequate health insurance coverage, features of health plans, and key federal and state policies. As new regulatory policies are enacted that expand access to MOUD, such as greater flexibility in OTPs and MOUD delivered via telehealth, it will be important to align these delivery changes with payment reform involving payers, providers, and policymakers.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Utilization management strategies are commonly used in Medicaid and private insurance plans to regulate SUD treatment benefits through mechanisms such as prior authorization, drug testing, annual maximums, duration restrictions, high deductibles, and monthly caps on total prescriptions.
“Moreover, utilization management strategies are commonly used in Medicaid and private insurance plans to regulate SUD treatment benefits through mechanisms such as prior authorization, drug testing, annual maximums, duration restrictions, high deductibles, and monthly caps on total prescriptions,24, 26, 34-35”
From County-Level Variation in Substance Use Disorder Service Utilization by Insurance Payers and Self-Pay in the United States (2026) · cites this paper as [24]
The Introduction identifies prior authorization as a health-plan utilization-management technique, and Results > Patient perspective describes duration restrictions and Medicaid monthly prescription caps. Discussion > Impact on patients also discusses high deductibles as a cost barrier. The cited passages do not establish drug testing or annual maximums as mechanisms, or classify high deductibles as utilization management; the paper addresses MOUD specifically rather than SUD treatment benefits generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe finding that 43.0% of SUD service utilizations were self-pay is consistent with documented barriers to SUD treatment, including lack of insurance, inadequate coverage benefits, cash-only payment acceptance, and patients' self-pay preference due to stigma-related privacy concerns.
“our finding that 43.0% of SUD service utilizations were self-pay is consistent with documented barriers to SUD treatment, including lack of insurance,24 inadequate coverage benefits across various insurance types,24, 31-36 cash-only payment acceptance (i.e., non-acceptance of any insurance) by SUD treatment providers,36 and patients’ self-pay preference due to stigma-related privacy concerns.24”
From County-Level Variation in Substance Use Disorder Service Utilization by Insurance Payers and Self-Pay in the United States (2026) · cites this paper as [24]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Larochelle, M. R., Bernson, D., Land, T., Stopka, T. J., Wang, N., Xuan, Z., Bagley, S. M., Liebschutz, J. M., & Walley, A. Y. (2018) · Annals of Internal Medicine · doi:10.7326/m17-3107 · Cited by 1,076
Comparative effectiveness of different treatment pathways for opioid use disorder.
Wakeman, S. E., Larochelle, M. R., Ameli, O., Chaisson, C. E., McPheeters, J. T., Crown, W. H., Azocar, F., & Sanghavi, D. M. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.20622 · Cited by 995
The triple wave epidemic: Supply and demand drivers of the US opioid overdose crisis
Ciccarone, D. (2019) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2019.01.010 · Cited by 677
Santo, T., Clark, B., Hickman, M., Grebely, J., Campbell, G., Sordo, L., Chen, A. B., Tran, L. T., Bharat, C., Padmanathan, P., et al. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2021.0976 · Cited by 614
Krawczyk, N., Rivera, B. D., Jent, V., Keyes, K. M., Jones, C. M., & Cerdá, M. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2022.103786 · Cited by 308
Retention of patients in opioid substitution treatment: A systematic review
O’Connor, A. M., Cousins, G., Durand, L., Barry, J., & Boland, F. (2020) · PLOS ONE · doi:10.1371/journal.pone.0232086 · Cited by 298
Cost-effectiveness of Treatments for Opioid Use Disorder
Fairley, M., Humphreys, K. N., Joyce, V. R., Bounthavong, M., Trafton, J. A., Combs, A., Oliva, E. M., Goldhaber‐Fiebert, J. D., Asch, S. M., Brandeau, M. L., et al. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2021.0247 · Cited by 163
Winhusen, T. M., Walley, A. Y., Fanucchi, L. C., Hunt, T., Lyons, M., Lofwall, M. R., Brown, J. L., Freeman, P. R., Nunes, E. V., Beers, D., et al. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108325 · Cited by 135
Krawczyk, N., Rivera, B. D., Levin, E., & Dooling, B. C. E. (2023) · The Lancet Public Health · doi:10.1016/s2468-2667(23)00023-3 · Cited by 101
Buprenorphine in the United States: Motives for abuse, misuse, and diversion
Chilcoat, H. D., Amick, H. R., Sherwood, M. R., & Dunn, K. E. (2019) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2019.07.005 · Cited by 100
Predictors of patient retention in methadone maintenance treatment.
Proctor, S. L., Copeland, A. L., Kopak, A. M., Hoffmann, N. G., Herschman, P. L., & Polukhina, N. (2015) · Psychology of Addictive Behaviors · doi:10.1037/adb0000090 · Cited by 99
Krawczyk, N., Fawole, A., Yang, J., & Tofighi, B. (2021) · Addiction Science & Clinical Practice · doi:10.1186/s13722-021-00275-1 · Cited by 94
Joudrey, P. J., Adams, Z. M., Bach, P., Buren, S. V., Chaiton, J. A., Ehrenfeld, L., Guerra, M. E., Gleeson, B., Kimmel, S. D., Medley, A., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.18223 · Cited by 79
Therapies Offered at Residential Addiction Treatment Programs in the United States
Beetham, T., Saloner, B. K., Gaye, M., Wakeman, S. E., Frank, R. G., & Barnett, M. L. (2020) · JAMA · doi:10.1001/jama.2020.8969 · Cited by 66
Saini, J., Johnson, B., & Qato, D. M. (2022) · American Journal of Public Health · doi:10.2105/ajph.2021.306577 · Cited by 60
Clark, R. E., Baxter, J. D., BARTON, B. A., Aweh, G. N., O’Connell, E., & Fisher, W. H. (2014) · Health Services Research · doi:10.1111/1475-6773.12201 · Cited by 48
Chhatwal, J., Mueller, P. P., Chen, Q., Kulkarni, N. S., Adee, M. G., Zarkin, G. A., Larochelle, M. R., Knudsen, A. B., & Barbosa, C. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.14925 · Cited by 48
Bohler, R. M., Freeman, P. R., Villani, J., Hunt, T., Linas, B. S., Walley, A. Y., Green, T. C., Lofwall, M. R., Bridden, C. L., Frazier, L. A., et al. (2022) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2022.100126 · Cited by 43
Self-citationImpact of Medicaid restrictions on availability of buprenorphine in addiction treatment programs
Andrews, C. M., Abraham, A. J., Grogan, C. M., Westlake, M. A., Pollack, H. A., & Friedmann, P. D. (2019) · American Journal of Public Health · doi:10.2105/ajph.2018.304856 · Cited by 43
Do out-of-pocket costs influence retention and adherence to medications for opioid use disorder?
Dunphy, C., Peterson, C., Zhang, K., & Jones, C. M. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108784 · Cited by 41
The Affordable Care Act and Opioid Agonist Therapy for Opioid Use Disorder
Mojtabai, R., Mauro, C., Wall, M. M., Barry, C. L., & Olfson, M. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201900025 · Cited by 38
The Development of Medications for the Treatment of Opiate and Cocaine Addictions
Institute of Medicine (1995) · National Academies Press eBooks · doi:10.17226/4906 · Cited by 32
Morgan, J. R., Quinn, E. K., Chaisson, C. E., Ciemins, E., Stempniewicz, N., White, L. F., Linas, B. P., Walley, A. Y., & LaRochelle, M. R. (2022) · Medical Care · doi:10.1097/mlr.0000000000001689 · Cited by 30
Trends in Methadone Dispensing for Opioid Use Disorder After Medicare Payment Policy Changes
Taylor, E. A., Cantor, J., Bradford, A. C., Simon, K. I., & Stein, B. D. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.14328 · Cited by 24
Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014
Reif, S., Creedon, T. B., Horgan, C. M., Stewart, M. T., & Garnick, D. W. (2017) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2017.1300360 · Cited by 21
Self-citationPrivate Coverage of Methadone in Outpatient Treatment Programs
Polsky, D. E., Arsenault, S. M., & Azocar, F. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201900373 · Cited by 20
Clemans-Cope, L., Lynch, V., Payton, M., & Aarons, J. (2022) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-022-00478-y · Cited by 18
O’Grady, M. A., Lincourt, P., Gilmer, E., Kwan, M., Burke, C., Lisio, C., & Neighbors, C. J. (2020) · Substance Abuse Research and Treatment · doi:10.1177/1178221820924026 · Cited by 16
Strahan, A. E., Desai, S., Zhang, K., & Guy, G. P. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.54590 · Cited by 16
Leech, A. A., McNeer, E. A., Roberts, A. W., Dusetzina, S. B., Lai, P., Morgan, J. R., & Patrick, S. W. (2023) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2023.2826 · Cited by 14
Financial sustainability of payment models for office-based opioid treatment in outpatient clinics
Hodgkin, D., Horgan, C. M., & Bart, G. B. (2021) · Addiction Science & Clinical Practice · doi:10.1186/s13722-021-00253-7 · Cited by 13
Self-citationHarris, S. J., Yarbrough, C. R., & Abraham, A. J. (2023) · Health Affairs · doi:10.1377/hlthaff.2023.00148 · Cited by 13
The Impact of HDHPs on Service Use and Spending for Substance Use Disorders
Eisenberg, M. D. (2022) · The American Journal of Managed Care · doi:10.37765/ajmc.2022.89250 · Cited by 13
Help Is on the Way: Medicare Coverage of Opioid Treatment Programs
Felix, C., Sharfstein, J. M., & Olsen, Y. K. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16281 · Cited by 12
Treitler, P. C., Nowels, M., Samples, H., & Crystal, S. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.12030 · Cited by 11
Shoulders, A., Andrews, C. M., Westlake, M. A., Abraham, A. J., & Grogan, C. M. (2023) · JAMA Health Forum · doi:10.1001/jamahealthforum.2023.2502 · Cited by 11
Fiellin, D. A. (2022) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001007 · Cited by 10
The Role of Health Plans in Addressing the Opioid Crisis: A Qualitative Study
Davis, M. T., Bohler, R. M., Hodgkin, D., Hamilton, G. A., & Horgan, C. M. (2022) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.209022 · Cited by 7
Self-citationIjioma, S. C., Chilcoat, H. D., & DeVeaugh‐Geiss, A. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.208980 · Cited by 4
Hughto, J. M. W., Moyo, P., & Green, T. C. (2022) · PubMed · doi:10.1097/adm.0000000000000980 · Cited by 4
Why Not Better and Cheaper? Healthcare and Innovation
Skinner, J. (2024) · Journal of Economic Literature · doi:10.1257/jel.62.1.317.r9 · Cited by 4
Financial Sustainability of Novel Delivery Models in Behavioral Health Treatment.
Hodgkin, D., Horgan, C. M., Brown, S. J., Bart, G. B., & Stewart, M. T. (2023) · PubMed · Cited by 3
Self-citationFrom Scientific Discovery to Covered Treatments
Blanco, C., Ling, S. M., & Compton, W. M. (2022) · JAMA · doi:10.1001/jama.2022.6469 · Cited by 3
Flagged first, then by citations
2 of the 45 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Davis, 2023, The role of health plans in addressing the opioid crisis: A qualitative study, Journal of Substance Use and Addiction Treatment, 149, 10.1016/j.josat.2023.209022 · DOI
Cited by
Sorted by citations
Breaking barriers: addressing opioid stigma in chronic pain and opioid use disorder
Edwards, K. A., Merlin, J. S., Webster, F., Mackey, S., & Darnall, B. D. (2024) · Pain · doi:10.1097/j.pain.0000000000003475 · Cited by 16
Admass, B. A., Admassie, B. M., Chekol, W. B., Alemu, E. A., Melesse, D. Y., Ferede, Y. A., Anteneh, D. G., Zeleke, M. E., Kassa, S., Wagaw, A. C., et al. (2025) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-025-00675-5 · Cited by 12
Fox, A. D., Messmer, S., Hayes, B. T., Salisbury‐Afshar, E., Chatterjee, A., & Jakubowski, A. U. (2026) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001672 · Cited by 3
Pippin, M. (2026) · Cureus · doi:10.7759/cureus.103848 · Cited by 2
Lowenstein, M., Perrone, J., Ritter, A. Z., & Aronowitz, S. V. (2025) · Innovation in Aging · doi:10.1093/geroni/igaf048 · Cited by 2
Medication Based Recovery in Opioid Use Disorder: A Clinical and Epistemic Imperative
Babul, A., Mahdavi, P., Hussain, M., Janjua, Z. H., & Babul, N. (2025) · Cureus · doi:10.7759/cureus.99631 · Cited by 2
Bailey, A., Kang, A. W. C., & Martin, R. A. (2026) · Substance Use & Addiction Journal · doi:10.1177/29767342261452648 · Cited by 1
Franz, B. A., Ford, J. H., Cheng, H. L., Garneau, H. C., Mount, K. A., & McGovern, M. P. (2025) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001556 · Cited by 1
Han, B., Compton, W. M., Jones, C. M., Stimson, D. T., Barfield, E. T., Bellgowan, J. F., Hobin, J. A., & Volkow, N. D. (2026) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.26m16340
Masai, T. W., Kuria, M. W., Ayinde, O. O., & Oleche, M. O. (2025) · PLOS mental health. · doi:10.1371/journal.pmen.0000383
Allocative efficiency of opioid overdose prevention strategies for people incarcerated in New Jersey
Scheidell, J. D., Frechette, J. M., Townsend, T., Zhou, Q., Manandhar-Sasaki, P., Kaldany, H., Connelly, K. L., Cortes, A. P., Su, J. I.-S., Charles, D. L., et al. (2025) · Harm Reduction Journal · doi:10.1186/s12954-025-01327-4
Opioid Use Disorder Care Presentations After High-deductible Health Plan Enrollment
Shuey, B., Zhang, F., Argetsinger, S., Costa, R., Wen, H., & Wharam, J. F. (2026) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001662
Zinsli, K. A., Mixson, L. S., Delaney, J. A., Feinberg, J., Stopka, T. J., Seal, D. W., Smith, G. S., Pho, M. T., Wu, E., Jenkins, W. D., et al. (2026) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001671
Reducing Buprenorphine Misinformation as a Strategy to Improve Adoption in Primary Care
Bogart, S. M., Fenstemaker, C., Abrams, E. A., King, K., Tripathy, R., Shalash, J., & Franz, B. A. (2026) · Substance Use & Misuse · doi:10.1080/10826084.2026.2672651
Policy and Payment Factors Influencing Adoption of Low-Barrier Buprenorphine Treatment
Lowenstein, M., Davis, M. H., Suhail-Sindhu, S., McMurtrie, G., Grande, D., Hinckley, J., & Aronowitz, S. V. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.18878
Self-citationLin, Y., Li, H., Nahata, M. C., Zhang, C., Ramey, O. L., & Liu, L. (2026) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20251314
Moyo, P., George, M., Hughes, L. D., Shireman, T. I., Donohue, J. M., Andrews, C. M., Peterson, L., & Hughto, J. M. W. (2026) · Medical Care · doi:10.1097/mlr.0000000000002366
Vroom, E. B., Bolton, C. D., Finley, E. P., & Potter, J. S. (2026) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2026.210082
Alnashri, Y., Gagnon, K. W., Wood, T. J., Ferguson, D., Figgatt, M. C., Dantzler, J., Giannouchos, T. V., Sen, B., Becker, D. J., & Jaiswal, J. (2026) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2026.2716010
Harris, S. J., Desai, I. K., Situ, Y., Meyer, A. M., Song, M., Shah, H., Whaley, S., Heidari, O., Allen, S. T., Krawczyk, N., et al. (2026) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2026.210093
Wood, M., Eldridge, L. A., Pope, C., Meyerson, B. E., & Norman, C. (2026) · American Journal of Undergraduate Research · doi:10.33697/ajur.2026.179
Metadata
- Authors
- Bowser, D., Bohler, R., Davis, M. T., Hodgkin, D., & Horgan, C.
- Affiliations
- Georgia Southern University (US)
- Brandeis University (US)
- Corresponding author
- Bohler, Robert
- Davis, Margot T.
- Hodgkin, Dominic
- Horgan, Constance
- Venue
- Journal of Substance Use and Addiction Treatment
- Publisher
- Elsevier BV
- Published
- 2024-10
- Volume
- 165
- Pages
- 209441
- ISSN
- 2949-8759 (ISSN-L)
- PMC
- PMC11463342
- OpenAlex
- W4399801988
- Cited by
- 19
- References
- 45
- Citations by year
- 2026: 12 · 2025: 6 · 2024: 1
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Substance Use and Addiction Treatment (publishedVersion, cc-by-nc)
- SSRN Electronic Journal (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion, cc-by-nc)
- Funders
- National Institute on Drug Abuse (P30DA035772)
- Substance Abuse and Mental Health Services Administration
- National Institutes of Health (R01GM987654, UM1DA049412, NCT04111939)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- opioid use disorder, medication-assisted treatment, access to treatment, treatment retention, health insurance coverage, cost sharing, provider reimbursement, administrative burden, opioid treatment programs, methadone, buprenorphine, HEALing Communities Study, opioid epidemic, payment reform
- MeSH terms
- Analgesics, Opioid, Buprenorphine, Health Services Accessibility, Humans, Massachusetts, Methadone, Opioid-Related Disorders, United States, Opiate Substitution Treatment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
