Buprenorphine prescribing for Medicaid beneficiaries down in 2020

During 2020, buprenorphine dispensed to Medicaid beneficiaries was significantly below prepandemic levels nationally, according to a research letter published online March 24 in JAMA Network Open.

William N. Dowd and Tami L. Mark, Ph.D., from RTI International in Research Triangle Park, North Carolina, investigated changes in buprenorphine prescribing to all Medicaid beneficiaries during the first year of the pandemic. Analysis included quarterly Medicaid State Drug Utilization Data from 2018 to 2020.

The researchers found that across Medicaid programs before the pandemic, units and prescriptions were increasing, while units per prescription was flat. The trend in units flattened, the trend in prescriptions flattened following an initial drop, and units per prescription increased and then remained elevated after the start of the pandemic. Total buprenorphine dispensed during the pandemic was significantly below prepandemic trends in 13 states, and it was significantly above trend in four states. During the first three-quarters of the pandemic, cumulative units dispensed was below the prepandemic trend by 92.75 per 1,000 Medicaid beneficiaries.

"The key finding of below-trend buprenorphine dispensing is particularly concerning given the increase in opioid overdose deaths over the same period," the authors write. "Further research should evaluate whether state-level changes affected quantity per prescription, and whether that mitigated access barriers."

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