What has been the impact of Medicaid expansion on the utilization of buprenorphine in treatment for opioid addiction? A team led by University of Kentucky College of Public Health researchers recently published their findings on this topic in the journal Medical Care. Authors include Dr. Hefei Wen (lead author), assistant professor of Health Management and Policy, Dr. Ty Borders, professor of Health Management and Policy and Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy.

[Photo: Dr. Ty Borders (left) and Dr. Hefei Wen]

Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment for opioid use disorder.

The objective of the researchers’ work was to examine whether Medicaid expansion and physician prescribing capacity may have impacted buprenorphine utilization covered by Medicaid.

Investigators used a quasi-experimental difference-in-differences design to compare the pre-post changes in Medicaid-covered buprenorphine prescriptions and buprenorphine spending between the 26 states that implemented Medicaid expansions under the Affordable Care Act in 2014 and those that did not. They examined Medicaid enrollees in the expansion states, the non-expansion states, and late-expansion states.

Data showed that quarterly Medicaid prescriptions for buprenorphine and spending on buprenorphine from the Centers for Medicare and Medicaid Services Medicaid Drug Utilization files 2011 to 2014.

State implementation of Medicaid expansions in 2014 was associated with a 70 percent increase (P<0.05) in Medicaid-covered buprenorphine prescriptions and a 50 percent increase (P<0.05) in buprenorphine spending. Physician prescribing capacity was also associated with increased buprenorphine utilization.

The investigators conclude that Medicaid expansion has the potential to reduce the financial barriers to buprenorphine utilization and improve access to medication-assisted treatment of opioid use disorder. Active physician participation in the provision of buprenorphine is needed for ensuring that Medicaid expansion achieves its full potential in improving treatment access.