(130) Buprenorphine Utilization Trends Resulting from Multiple State Insurance Reimbursement Policy Changes: An Exploratory Joinpoint Analysis

Publication Number: 804

Background: Buprenorphine and methadone are the only opioid use disorder (OUD) therapies associated with reduction in opioid-involved mortality. Buprenorphine reimbursement policies in state Medicaid insurance programs are in flux and several barriers continue to limit prescribing.

Objectives: The purpose of this study was to examine patterns of buprenorphine utilization in a large state Medicaid program to identify likely policy drivers of significant shifts in trends.

Methods: We conducted a time series trend analysis using publicly reported data from the Florida state Medicaid enrollment files and the Medicaid State Drug Utilization Database. Buprenorphine medications (single agent and buprenorphine/naloxone combination products) with OUD indications were identified via National Drug Codes and aggregated to total prescriptions in Florida Medicaid per quarter. Monthly Florida Medicaid enrollment for those aged 18 and older were averaged to quarterly enrollment. The quarterly measure was constructed as total prescriptions reimbursed per 10,000 adult enrollees from quarter 1 (Q1) 2016 to Q1 2021. Joinpoint regression was used to identify significant shift points (joinpoints) in the trend via Monte Carlo Permutation method. Measures were log-transformed to calculate Quarter percent changes (QPC) between joinpoints.

Results: A total of 202,732 buprenorphine prescriptions were reimbursed during the study period, ranging from 33 prescriptions/10,000 enrollees in Q1 2016 to 73 prescriptions/10,000 enrollees in Q1 2021. A single significant joinpoint was identified in Q2 2019, where the QPC= 4.51% for the first period (prior to the joinpoint break) and QPC=0.77% for the second period (following the joinpoint break). The weighted average QPC was 3.4% throughout the study period, meaning there was an average increase in 3.4% prescriptions/10,000 enrollees during each quarter evaluated. The timing of the break aligns with the addition of new buprenorphine generic formulations in this state’s covered drug list in early 2019.

Conclusions: There was an increase in overall buprenorphine use in every quarter of the study period. Despite multiple policy reimbursement changes aimed at increasing buprenorphine accessibility in the Florida Medicaid program during the study period, we only identified a single significant break in the trend likely associated with formulary changes. Earlier policies related to reimbursement (e.g., removal of prior authorization requirements in Q1 2018) were not associated with significant deviations on increasing utilization trends.