Pronounced State Level Disparities in Medicaid Prescribing of Buprenorphine for Opioid Use Disorder (2019-2020)

Objective To analyze buprenorphine prescription distribution across states in Medicaid patients during 2019-2020. Methods Buprenorphine prescriptions per Medicaid enrollee per state was calculated for 2019 and 2020. The totals of monoproduct buprenorphine were divided over the total of combination buprenorphine/naloxone in 2019 and 2020 to obtain the ratio of mono/combo. Data analysis was conducted with generic and brand name formulations of buprenorphine, and transmucosal buprenorphine/ naloxone combinations FDA-approved for OUD using Microsoft Excel. Formulations of buprenorphine indicated for pain were excluded. States outside 95% confidence intervals (mean +1.96*SD) were considered statistically significant. Results The overall change in buprenorphine prescribing between 2019 and 2020 was modest (+3.6%) but highly variable with > 10% increases in 17 states (Iowa = +100.5%, p 10% decrease in nine states (Alabama = −68.5%, p < 0.05). Total amount reimbursed in 2019 increased (+9.9%) to $1.42 billion in 2020. Branded formulations accounted for two-fifths (39.5%) of prescribing but over two-thirds (66.8%) of spending in 2020. There was a 50-fold difference in prescribing between the highest (Vermont = 219.5 prescription / 1,000 enrollees, p < 0.05) and lowest (Texas = 4.4) states in 2019. This disparity increased in 2020 resulting in a 278-fold difference. Conclusions The COVID-19 pandemic exacerbated state-level disparities in buprenorphine prescribing for OUD among Medicaid patients. Legislation on buprenorphine waivered providers and Medicaid expansion may explain the statistically significant percent changes in state buprenorphine prescriptions.