JAMA Health Forum. 2022;3(6):e221757. doi: 10.1001/jamahealthforum.2022.1757
Buprenorphine Prescriptive Trends Following Removal of Prior Authorization Policies for the Treatment of Opioid Use Disorder in Two State Medicaid Programs
By Shailina Keshwani, BS, BAS, MS; Michael Maguire, MS; Amie Goodin, PhD, MPP; et al Wei-Hsuan Lo-Ciganic, PhD, MS, MSPharm; Debbie L. Wilson, PhD, RN; Juan M. Hincapie-Castillo, PharmD, PhD, MS
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Effective April 28, 2021, the Department of Health and Human Services (HHS) removed a key barrier to obtaining an X-Waiver for prescribing buprenorphine by exempting covered practitioners from certain requirements. This regulatory change makes it easier for practitioners to obtain an X-Waiver to prescribe buprenorphine to patients with opioid use disorder (OUD).
Question: What are the outcomes of removing prior authorizations (PAs) on buprenorphine for opioid use disorder (OUD) in Medicaid programs?
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.
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.