The Impact of Eliminating the X-waiver in Wisconsin

• In Event: Increasing Access to Medications for Opioid Use Disorder

Abstract

The Impact of Eliminating the X-waiver in Wisconsin: Until recently, residents in rural counties have faced limited access to buprenorphine due to a shortage of X-waivered clinicians who are permitted to prescribe it. Following guidance on the removal of the X-Waiver issued by Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA), the Consolidated Appropriations Act of 2023 effectively eliminated the “DATA-Waiver Program” removing a crucial administrative barrier for buprenorphine prescribing as of January 1, 2023. However, robust evidence on whether the X-Waiver elimination impacted buprenorphine prescribing is limited. In this study, we employ a Difference-in-Differences approach to assess whether Medicaid covered buprenorphine prescriptions and individuals receiving prescriptions increased after the elimination of the X-waiver by comparing rates of each before and after the policy change across individuals with an opioid use disorder (OUD) – a requisite for buprenorphine – compared to those with a non-opioid substance use disorder (SUD) diagnosis. We additionally compare outcomes across rural county residents, for whom access faced geographic constraints prior to 2023, to urban residents. We leverage linked administrative records from the Wisconsin Administrative Data Core (WADC) that capture the universe of buprenorphine prescriptions for Medicaid enrollees linked to an array of demographic and health outcomes. Our preliminary evidence suggests that rural counties experienced an increase in the proportion of Medicaid enrolled individuals receiving buprenorphine relative to urban counties, while we find no significant effects on the number of buprenorphine prescriptions. These results coincide with previous research that the X-waiver elimination has a marginal impact on MOUD access. Our findings support the notion that additional policy efforts are needed to promote MOUD access for underserved communities, such that substantial policy interventions are needed.

Author: Taehwan Choi, University of Wisconsin - Madison (Sandra Rosenbaum School of Social Work)

Keywords: Drug Use, Health, Public Health

Author

• Taehwan Choi, University of Wisconsin-Madison
  Presenting Author