Dataset Information

Buprenorphine Use Trends Following Removal of Prior Authorization Policies for the Treatment of Opioid Use Disorder in 2 State Medicaid Programs

ABSTRACT: This cross-sectional study evaluates the changes in buprenorphine use for opioid use disorder among Medicaid enrollees in states that completely removed buprenorphine prior authorization requirements. Key Points

Question

What are the outcomes of removing prior authorizations (PAs) on buprenorphine for opioid use disorder (OUD) in Medicaid programs?

Findings

In this cross-sectional study of Medicaid State Drug Utilization Data from 2 states, buprenorphine prescribing for OUD in the state Medicaid program of Illinois increased after removing PA requirements, whereas a similar increase was not observed in the state Medicaid program of California.

Meaning

Policies removing PA requirements for buprenorphine prescribing for treatment of OUD may improve access to OUD treatment in Medicaid enrollees.

Importance

State Medicaid programs have implemented initiatives to expand treatment coverage for opioid use disorder (OUD); however, some Medicaid programs still require prior authorizations (PAs) for filling buprenorphine prescriptions.

Objective

To evaluate the changes in buprenorphine use for OUD among Medicaid enrollees in states that completely removed buprenorphine PA requirements.

Design, Setting, and Participants

This retrospective cross-sectional study analyzed the immediate and trend changes on buprenorphine use during 2013 to 2020 associated with removal of PA requirements using a controlled interrupted time series analysis to account for autocorrelation. Data were collected from Medicaid State Drug Utilization Data for 2 states (California and Illinois) that completely removed a buprenorphine PA during the study period, and buprenorphine prescriptions for OUD treatment were identified among Medicaid enrollees.

Main Outcomes and Measures

Quarterly total number of buprenorphine prescriptions for each state was calculated, and stratification analyses were conducted by dosage form (films and tablets).

Results

Among the 2 state Medicaid programs (California and Illinois) that removed buprenorphine PAs, there was a total of 702 643 and 415 115 eligible buprenorphine prescription claims, respectively. After removing PA requirements for buprenorphine, there was an immediate increase that was not statistically significant (rate ratio [RR], 1.11; 95% CI, 0.76-1.61) in the number of all buprenorphine prescriptions in California and a statistically significant increase (RR, 6.99; 95% CI, 4.67-10.47) in the number of all buprenorphine prescriptions in Illinois relative to the change in the control states (Alabama, Florida, Idaho, Kansas, Mississippi, Nevada, South Dakota, and Wyoming). Additionally, there was a statistically significant decreasing trend in the number of all buprenorphine prescriptions in California (RR, 0.88; 95% CI, 0.82-0.94) and a statistically significant increasing trend in Illinois (RR, 1.11; 95% CI, 1.05-1.19) relative to the trend in control states.

Conclusions and Relevance

In this cross-sectional study, removal of buprenorphine PA requirements was associated with a statistically significant increase in the number of buprenorphine prescription fills among Medicaid populations in 1 of the 2 included states.

SUBMITTER: Keshwani S

PROVIDER: S-EPMC9233239 | biostudies-literature |

REPOSITORIES: biostudies-literature

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