June 24, 2022

Removing the Medicaid requirement for prior approval to fill prescriptions for buprenorphine – a common treatment for opioid use disorder (OUD) – could lead to more patients gaining access to this life-saving medication.

While many state Medicaid programs are working to expand coverage of buprenorphine prescriptions, some states still require prior authorization (PA) before they can be filled. This means that pharmacies must go through the extra step of contacting a prescriber and having them send advanced approval to a health insurance payer to prove that the prescription is medically necessary.

Without a PA, many health insurances, including Medicaid, may refuse to cover these prescriptions or cover them at a higher cost. PAs can take several business days to process, and this can cause significant delays in care for patients and lead to a higher risk of relapse. Many health care providers consider PAs in Medicaid programs the biggest barrier to accessing medication for opioid use disorder (MOUD).

A new study, published today in JAMA Health Forum, suggests that removing state Medicaid’s requirement for PAs could lead to an increase in buprenorphine prescription fills.

Dr. Juan Hincapie-Castillo

Dr. Juan Hincapie-Castillo

“Asking Medicaid-insured individuals to go through PA requirements adds to the many existing barriers of care that exist for this patient population,” said lead author Juan Hincapie-Castillo, PharmD, PhD, assistant professor of epidemiology at the UNC Gillings School of Global Public Health and the Injury Prevention Research Center. “While PAs are justified for cases of very costly medications, proper treatment of OUD is hindered severely the more policy hurdles are put in place.”

Hincapie-Castillo led the study along with researchers at the University of Florida, Gainesville. The team examined how the complete removal of the PA requirements in Medicaid programs in California and Illinois impacted the number of buprenorphine prescriptions filled and the trend of prescription fills between 2013 and 2020.

Without the barrier of PAs, the research team found that prescriptions for buprenorphine increased immediately in Illinois and continued to increase. However, in California, they only saw a minor increase immediately after PA restrictions were lifted, and the trend in the rate of filling buprenorphine prescriptions decreased over time. This difference in results may be due to the more administrative burden for PA processing that existed in Illinois than in California at the time of the policy change.

“The different results between the states we evaluated illustrate, once again, the need for careful understanding of not only the presence of a policy but also the administrative burden of implementing these restrictions,” said Hincapie-Castillo.

Prior authorization requirements are one of many factors that affect buprenorphine prescription fills, as the findings suggest. Policy changes that impact prescribing – including waivers that expand the types of providers who can write buprenorphine prescriptions – prescriber specialty and treatment preferences, and concerns about diversion can also impact the use of buprenorphine in OUD treatment.

“The rates of drug overdoses continue to increase in the United States, and more efforts are needed to provide adequate management and treatment of OUD. We hope that these findings can provide evidence on the need to remove unnecessary barriers to prescribing treatments that save patient lives,” said Hincapie-Castillo. “Our work also needs to expand significantly to address the health inequities that persist in prescribing of these medications.”

Read the full article.

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