Need for buprenorphine demonstrated in Medicaid data

A new brief from the Urban Institute shows that Medicaid programs nationwide have seen increases in buprenorphine prescriptions and in the number of people receiving buprenorphine since 2014. Uptake varies between the states that expanded Medicaid eligibility under the Affordable Care Act (ACA) and the non-expansion states, however.

The 26 expansion states demonstrated a 129.4% increase in prescriptions between the fourth quarter of 2013 (pre-ACA) and the third quarter of 2016. By comparison, the 19 nonexpansion states showed an increase of just 29.3% during that time. Trends among the remaining states that expanded Medicaid later showed significant increases as well.

The brief aims to analyze ACA coverage gains and how that has affected utilization of buprenorphine, according to Lisa Clemans-Cope, senior researcher and health economist for the Urban Institute and lead author of the study.

“States that had Medicaid expansion had a very large increase in buprenorphine prescriptions after expansion, and the increase among the nonexpansion states was much lower,” Clemans-Cope tells Behavioral Healthcare Executive. “That is for total buprenorphine prescriptions but also per-person.”

When analyzing prescriptions per 1,000 enrollees, researchers found higher use of buprenorphine in expansion states in the years prior to ACA as well as higher growth trends after ACA implementation. Expansion states demonstrated a 41.2% increase in buprenorphine prescriptions per enrollee between the fourth quarter of 2013 and the third quarter of 2016. Nonexpansion states showed a lower growth trend of 17.2% in the same time period.

“Since the opioid epidemic is widespread across Medicaid expansion states and states that didn’t expand, it suggests there is a shortage in meeting treatment need,” Clemans-Cope says. “And the need for treatment is probably pretty acute in the non-expansion states.”

Even so, researchers believe there are still capacity shortages in expansion states, she says. All Medicaid programs include buprenorphine coverage, and data was collected from fee-for-service and managed Medicaid records.