Association for Public Policy Analysis & Management

Opioid addiction has created a national crisis, with the epidemic disproportionately affecting Medicaid beneficiaries. Medication-assisted treatment (MAT) with buprenorphine is a key strategy for treating people with opioid use disorder (OUD). However, there is an insufficient number of healthcare providers who are authorized and willing to provide MAT. The Comprehensive Addiction and Recovery Act of 2016 (CARA 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. The first waivers for NPs and PAs were approved in February 2017. We examined the patterns and trends in the receipt of buprenorphine treatment for OUD from various prescriber types by Medicaid beneficiaries compared to other payer types post-CARA 2016.

The study, spanning 7/2017 to 6/2018, used three datasets: Symphony Health (IDV^®), which captures over 90% of US retail pharmacy prescription fills, the National Plan and Provider Enumeration System which gives provider taxonomy, and the Urban Influence Codes which identify the degree of urbanicity. We identified claims for buprenorphine drugs indicated for treating OUD, alongwith the payment type (Medicaid, Medicare, commercial insurance or cash) and classified prescribers as physicians, NPs, or PAs. We summarized the data using descriptive statistics and explored associations using regressions.

About 40% of patients in the analytic dataset had buprenorphine prescriptions paid by Medicaid. During the period, 365,591 Medicaid beneficiaries received buprenorphine, with a 12% increase in the number of patients over the year, which was twice the increase for the 909,300 patients observed overall. The proportion of Medicaid beneficiaries receiving prescriptions from physicians declined from 97.9 percent in quarter 1 to 92.7 percent in quarter 4. Over the same period, the proportion receiving prescriptions from advanced practitioners (NPs and PAs) tripled, from 5.3% to 15.1%. About 11% of Medicaid beneficiaries in the dataset received buprenorphine from both physicians and advanced practitioners. A total of 37,380 providers prescribed buprenorphine over the year, and 60.5% prescribed to Medicaid beneficiaries. Providers who prescribed buprenorphine to Medicaid beneficiaries treated more patients per month than providers who did not (a median monthly patient load per provider of 16 vs. 2 in June 2018). Regression analysis adjusting for patient gender, age, prescriber’s rural/urban location and state NP prescriptive authority status showed that Medicaid beneficiaries were more likely to receive buprenorphine prescriptions from advanced practitioners than patients covered by Medicare or commercial insurance, and those who paid in cash.

To the best of our knowledge, this is the first study that explores improvement in the receipt of buprenorphine among Medicaid beneficiaries since the passage of CARA 2016, particularly from advanced practitioners who became newly eligible to prescribe buprenorphine. The 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.