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One Year After ‘X Waiver’ Axing, Few New Patients Prescribed Meds for OUD
Though the number of buprenorphine prescribers increased following the elimination of the X waiver in January 2023, the total number of patients using the medication to manage opioid use disorder (OUD) “changed little.” Study results were published in The New England Journal of Medicine in a letter to the editor.
“Our findings suggest that the policy may have reduced barriers to prescribing but was insufficient to meaningfully increase buprenorphine use through the end of 2023,” said Kao-Ping Chua, MD, PhD, University of Michigan Medical School, Ann Arbor.
The University of Michigan research team utilized the IQVIA Longitudinal Prescription Database to evaluate the changes in buprenorphine prescribing patterns following the X waiver policy change. They then calculated the number of prescribers ordering buprenorphine dispensation, the number of patients receiving dispensation, and the number of new patients initiating treatment with buprenorphine, for each month during 2022 and 2023. Outcomes were assessed using an interrupted-time-series design to assess changes starting in January 2023, as well as the monthly rate of change in outcomes (“slope change”).
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Buprenorphine Prescribers Rate of Change
Between January and December 2022, the monthly number of buprenorphine prescribers increased from 38,684 to 42,158. In January 2023, there was a level increase of 1938 prescribers (95% confidence interval [CI], 990 to 2887) and a slope increase of 595 prescribers per month (95% CI, 393 to 786). As of December 2023, there were 53,635 buprenorphine prescribers.
Buprenorphine Dispensing to Patients Rate of Change
In contrast, between January and December 2022, the monthly number of patients to whom buprenorphine was dispensed showed a modest increase, from 810,911 to 831,656. In January 2023, there was no substantial level change in the number of patients with prescriptions (2683; 95% CI, −6751 to 12,117) or slope change (−857 patients per month; 95% CI, −2943 to 1229).
Buprenorphine Treatment Initiation Rate of Change
Between January and December 2022, the monthly number of patients in whom buprenorphine treatment was initiated decreased from 51,692 to 46,565. In January 2023, there was a level increase of 5245 new patients (95% CI, 3375 to 7114) but no substantial slope change (34 new patients per month; 95% CI, −336 to 404). In December 2023, buprenorphine treatment was initiated in 48,247 patients.
"The fact that this policy failed to increase the number of patients with buprenorphine prescriptions through the first year of implementation highlights the many other barriers to buprenorphine prescribing that must be overcome," noted Thuy Nguyen, PhD, senior study author, in a press release.
Authors noted several limitations of the study, including the lack of information on what disease state buprenorphine was prescribed for and the possibility that significant changes enacted by the policy may take longer than 1 year to manifest.
This research was supported by multiple grants from the National Institute on Drug Abuse (NIDA), the National Institute of Mental Health, and other US-based government and/or 501(c)(3) organizations.
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