Removing PA requirements for buprenorphine did not increase prescriptions

Abstract

A study of 23 states from 2015 to 2019 found that the removal of prior authorization (PA) requirements, thought to be a barrier to buprenorphine prescribing, in Medicaid programs did nothing to increase prescribing. The study, “Removal of Medicaid Prior Authorization Requirements and Buprenorphine Treatment for Opioid Use Disorder,” which published in JAMA Health Forum on Oct. 4, did show some association in increased prescribing in states with low prescribing levels at baseline, but not in states with higher baseline prescribing. The findings do not mean that prior authorization—a technique used by payers to control utilization—is not a barrier, but rather, that it is not the only barrier, and that other barriers must be removed in order to increase prescribing of buprenorphine. Study results showed that: 1) six states in the sample removed Medicaid PAs for at least one buprenorphine formulation; 2) states that kept their PA requirements had lower buprenorphine prescribing and lower Medicaid managed care penetration, but similar opioid overdose rates to states that removed the PA requirements; and 3) for states with below‐median baseline buprenorphine prescribing, PA removal was associated with increased buprenorphine prescriptions, while states with above‐median prescribing showed no change. The researchers concluded that more efforts are needed to increase availability of buprenorphine. The lead author is Paul J. Christine, M.D., Ph.D., of the University of Colorado School of Medicine.