The number of Medicaid-covered prescriptions for buprenorphine, a key drug used to treat opioid addiction, increased dramatically in states that expanded Medicaid under the Affordable Care Act while remaining relatively static in non-expansion states, according to a new study from researchers at the Urban Institute.
Between 2011 and 2018, the number of buprenorphine prescriptions in the Medicaid program increased nearly fivefold, from 1.3 million to 6.2 million, the researchers found. The jump was largely the result of Medicaid expansion, with 4.8 million prescriptions -- or about 77% -- being filled in expansion states.
The analysis, which is based on Medicaid state drug utilization data, “suggests a large-scale increase in access to treatment, especially in expansion states, and particularly in a few states such as Vermont and West Virginia,” the researchers write.
Meanwhile, most states that chose not to expand Medicaid have low rates of buprenorphine prescriptions among Medicaid beneficiaries. Those states include Florida, Missouri, South Carolina, Tennessee, Utah and Wisconsin -- all of which have opioid-related death rates higher than the national average.
“Medicaid expansion in these states would likely increase the share of people with access to both overdose reversal and treatment drugs, potentially increasing provider capacity and access to treatment and providers,” the researchers say.
Gerard Vitti, a Medicaid expert and CEO of Healthcare Financial, Inc., said the findings show the importance of Medicaid expansion and the risks posed by the Trump administration’s support of policies like work requirements, beneficiary cost-sharing and lockout periods in Medicaid. Those policies, when applied to vulnerable beneficiaries who received coverage via Medicaid expansion, threaten to undermine the gains in expanded treatment that have resulted from expansion.
“Not all expansions are equal,” Vitti said. “If you have some of these conservative principles and you have some of these people who, by definition, can’t be compliant, they’ll be kicked off the rolls. And if they’re in crisis or in treatment and are taking medication and will not have access to those medications, you’re going to see it in the streets, you’re going to see it in the alleys, you’re going to see it in the backs of ambulances and you’re going to see it in higher crime.”
Buprenorphine is one of three FDA-approved medications to treat opioid use disorder, and many experts say expanding access to medication-assisted treatment is essential to fight the opioid crisis. The researchers at the Urban Institute’s Health Policy Center tabulated state-by-state Medicaid-covered buprenorphine prescriptions but did not examine methadone or naltrexone, the other two medications used to treat opioid use disorder.
The study found extremely stark disparities in buprenorphine rates among states. Vermont had by far the highest rate, with 1,210 Medicaid-covered buprenorphine prescriptions per 1,000 Medicaid enrollees ages 12 and older in 2018. The state with the next-highest rate, West Virginia, had 827 prescriptions per 1,000 enrollees. Many people on medication-assisted treatment may receive multiple prescriptions per month.
In contrast, Florida had 12 Medicaid-covered buprenorphine prescriptions per 1,000 enrollees, Texas had 8, and Arkansas had 5, the lowest in the nation. Arkansas was the only expansion state in the bottom seven states in terms of number of buprenorphine prescriptions.
The researchers highlighted Vermont’s high buprenorphine rate. The state used its Medicaid expansion to implement a “hub-and-spoke” treatment model that dramatically expanded access to medication-assisted treatment. The researchers also said that Vermont’s high prescribing rate may reflect higher dosing, because a typical dose of 16 milligrams of buprenorphine is typically taken as two eight-milligram tablets. Evidence suggests higher doses of buprenorphine are more effective in treating addiction. -- James Romoser (jromoser@iwpnews.com)
