Impact of Recent Medicaid Expansion on Buprenorphine Prescriptions

• In Event: Opioid Use Disorder - Treatment and Analysis

Abstract

As the United States continues to address the opioid epidemic, buprenorphine has emerged as an effective treatment for opioid use disorder (OUD). Despite its clinical value and recent policy changes - such as the removal of the X-waiver, expanded prescribing authority for nurse practitioners, and allowance of telehealth prescribing - buprenorphine remains underutilized. While earlier research has shown that initial Medicaid expansions following the enactment of the Affordable Care Act (ACA) increased buprenorphine access in some areas, little is known about the effects of more recent expansions, particularly those implemented during the COVID-19 pandemic. 

This study uses national IQVIA retail pharmacy data (2013–2024) and staggered-adoption difference-in-differences methods to assess the impact of these later Medicaid expansions on buprenorphine prescribing. Unlike prior studies, our analysis accounts for variation in implementation timing and a changing policy landscape characterized by greater public awareness of OUD treatment and fewer regulatory barriers. Preliminary findings suggest that post-2018 Medicaid expansions increased buprenorphine access for Medicaid enrollees, with the rise in Medicaid-paid prescriptions partially offset by a decline in prescriptions paid through commercial insurance. We find no significant impact on all-payer prescribing rates, despite a continued upward trend in overall buprenorphine utilization. These results indicate substitution across payer types, highlighting the role of Medicaid in accessing care. 

Our findings highlight that recent Medicaid expansions led to increased buprenorphine use in late-adopting states, which often face greater barriers to care and house high-risk populations. These results emphasize the critical role of public coverage in improving access to essential treatment for opioid use disorder. 

Authors

• Nicole Y Siegal, Indiana University
  Presenting Author

• Kosali Simon, Indiana University
  Non-Presenting Co-Author

• Sumedha Gupta Gupta
  Non-Presenting Co-Author

• Hillary Samples, Rutgers University
  Non-Presenting Co-Author

• Jennifer Miles, Rutgers University - New Brunswick
  Non-Presenting Co-Author