Despite X-Waiver Elimination, Buprenorphine Rx Decline

TOPLINE:

After the elimination of the mandatory training required to prescribe buprenorphine for opioid use disorder, prescriptions for the drug declined the next year, new research shows. However, total doses increased as well as Medicaid payments for prescriptions, results of a new study show.

METHODOLOGY:

Physicians have been allowed to prescribe buprenorphine, a partial opioid agonist approved by the Food and Drug Administration (FDA) to treat opioid use disorder (OUD), under strict guidelines, including completing 8 hours of structured education and obtaining an X‐waiver from the Drug Enforcement Agency.However, in 2021, the Department of Health and Human Services released new practice guidelines allowing physicians to forego the training prerequisite, and in 2022, the X-waiver requirement for practitioners to prescribe medications like buprenorphine was eliminated.The retrospective, observational analysis used 2020-2021 Centers for Medicare & Medicaid Services State Drug Utilization Data (CMS SDUD), which includes reports by individual US states for covered outpatient drugs paid by state Medicaid agencies.Researchers compared the annual total number and doses of dispensed buprenorphine prescriptions and annual state Medicaid payments for these prescriptions between 2020 and 2021.

TAKEAWAY:

The total number of buprenorphine prescriptions dispensed in all states was 5,813,262 in 2020 and 5,635,019 in 2021, a 3.1% decrease.Twenty-four state Medicaid programs (47%) had a lower total number of buprenorphine prescriptions dispensed in 2021 vs 2020. Rhode Island (-70.2%), Hawaii (-70.1%), and Texas (-62.1%) had the highest percent decrease in prescriptions.Doses of buprenorphine prescriptions dispensed totalled 150,969,086 in 2020 and 155,751,403 in 2021, accounting for a 3.2% increase. Nebraska (+83.8%), South Dakota (+41.1%), and New York (+37.1%) had the highest percent increase in total doses dispensed.Total Medicaid payment for buprenorphine prescriptions dispensed was $1,176,555,134 in 2020 and $1,300,973,311 in 2021, for a 10.6% increase. South Dakota (+147.2%), Nebraska (+88.6%), and New York (+72.6%) had the highest percent increase in Medicaid payments.

IN PRACTICE:

The findings suggest “removal of X‐waiver training alone is not adequate to increase prescribing and access” to buprenorphine, and the “enormous gap” between the number of patients with OUD and those who actually receive OUD treatment “needs to be addressed,” the researchers write.

SOURCE:

The study was led by Jingjing Qian, PhD, Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, Auburn, Alabama. It was published online December 9, 2023, in the American Journal on Addictions.

LIMITATIONS:

CMS SDUD may have incomplete or inaccurate information on dispensed prescriptions. As the study period was during the COVID‐19 pandemic, buprenorphine prescribing might have been impacted by limited in ‐ person access to clinicians. The decline in the number of buprenorphine prescriptions could be due to changing composition of prescriptions and not change in the actual number of patients getting buprenorphine. As buprenorphine prescribing is relatively complicated at the state level, it may have been affected by factors not considered.