Association for Public Policy Analysis & Management

Opioid epidemic has reached a national crisis in the United States (US), especially among Medicaid beneficiaries. Medication-assisted treatment (MAT) with buprenorphine, together with counseling and social support, is a key strategy for treating opioid dependence. However, there is an insufficient number of healthcare providers who are trained, authorized, and willing to provide MAT. The Comprehensive Addiction and Recovery Act of 2016 sought to address this gap by authorizing qualified nurse practitioners (NPs) and physician assistants (PAs) to prescribe buprenorphine to the extent allowed by state laws.

Using Symphony Health (IDV^®), spanning 7/2017 to 6/2018, we provide the first comprehensive characterization of buprenorphine prescribing patterns and trends for NPs, PAs, and physicians in the US. IDV^® captures over 90% of US retail pharmacy fills and contains detailed information including fill date, drug code, prescriber identifier, and selected de-identified, HIPAA compliant patient information.

We identified claims for buprenorphine drugs indicated for treating opioid use disorder (OUD), along with the payer for each claim. We classified prescribers as physicians, NPs, or PAs based on taxonomy codes from the National Plan and Provider Enumeration System. Using IDV information, we determined prescriber geographic location and selected patient demographic characteristics. We explored data using descriptive statistics and regression modeling.

Between 7/2017 and 6/2018, 37,380 providers prescribed buprenorphine for OUD. Of them, 18.5% were advanced practitioners (4,828 NPs and 2,099 PAs). The number of observed prescribers rose each study quarter for every prescriber category, with the largest increase of almost 80% for NPs, followed by a 50% increase for PAs and a 4.5% increase for physicians.

The number of patients receiving buprenorphine for OUD increased from 581,596 in Q1 to 616,200 in Q4. The most prominent increase came from patients receiving prescriptions from NPs - from 17,821 in Q1 to 50,317 in Q4, a 182.3% increase. The number of patients receiving prescriptions from PAs also rose substantially, from 8,559 in Q1 to 20,734 in Q4 (a 142.2% increase). In contrast, patients receiving prescriptions from physicians increased only 2.1%, from 570,450 in Q1 to 582,420 in Q4.

We also found notable geographic variations in prescribing patterns and trends. Rural areas had a higher share of advanced practitioner prescribers than did urban areas and states that allow NP independent prescribing had a higher proportion of advanced practitioner prescribers than did states where physician oversight is required.

The study has descriptive value, as little is known about prescribing patterns for buprenorphine medications among NPs and PAs and more needs to be known about physician prescribing patterns. The results based on retail pharmacy data indicate a strong and robust increase in the number of buprenorphine prescribers, especially among advanced practitioners. These timely findings shed light on policies responding to the current opioid crisis through expanded coverage of treatment and innovation in care delivery.

The research underlying this abstract was completed with support from the Medicaid and CHIP Payment and Access Commission (MACPAC). The findings, statements, and views expressed are those of the authors and do not necessarily represent those of MACPAC.