Buprenorphine Prescribing for Opioid Use Disorder Treatment in Medicaid Expansion and Non-Medicaid Expansion States
21 Pages Posted: 4 Jun 2022
Introduction: Medication is the gold standard for opioid use disorder treatment. However, buprenorphine for OUD prescribing remains low in many U.S. communities. This study examines characteristics of buprenorphine waivered clinicians and the number of patients treated in Medicaid expansion and non-expansion states.
Methods: We matched information on buprenorphine waivered clinicians and patient limits from DEA and SAMHSA April 2019 files with clinician-level buprenorphine prescribing information from Symphony Health Integrated Dataverse to determine buprenorphine waivered clinician characteristics and calculate monthly clinician-level patient census from April 2017 to January 2019.
Results: The analysis included 55,938 waivered clinicians, of which 51% (n=28,446) were active prescribers. Primary care providers were the most common medical specialty (n=19,026) with 60% actively prescribing. The percentage of active prescribers was higher among addiction medicine (n=996; 75%) and pain medicine (n=1,702; 70%) specialists. The majority of waivered clinicians had the 30-patient limit (n=42,508), 39% (n=16,523) of whom actively prescribed. There were fewer 100 (n=8,923) and 275-patient limit (n=4,507) waivered clinicians but active prescribing was higher at 84% (n=7,504) and 98% (4,419), respectively. The percentage of active prescribers (50% vs. 56%) and the monthly median patient census (7.9 vs. 9.9) were slightly larger in non-Medicaid expansion as compared to expansion states. However, active prescribers per capita (10.1 vs. 6.0) was slightly larger in Medicaid expansion states. The monthly median patient census was relatively similar in Medicaid expansion and non-expansion states among providers with 30 (3.4 vs. 3.5) and 100 (24.4 vs.23.0) patient limits but was noticeably larger among 275 patient limit prescribers in Medicaid expansion as comparison to non-Medicaid expansion states (105.5 vs. 94.5). Active prescribers per capita was somewhat larger in Medicaid expansion states for all patient limits ((30: 6.0 vs. 3.1), (100: 2.6 vs. 1.7), (275: 1.5 vs. 1.1)).
Conclusions: Medicaid expansion as compared to non-Medicaid expansion states have more potential to improve treatment access with the current prescriber workforce. However, efforts in both Medicaid expansion and non-expansion states are needed to increase buprenorphine prescribing.
Funding Information: Support for this research was provided by The Pew Charitable Trusts and Deerfield Management Company.
Declaration of Interests: None.
Keywords: Buprenorphine, Medicaid expansion, Opioid use disorder
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