003 - Evaluating the relationship of state Medicaid initiatives with patient- and provider-level changes in buprenorphine treatment for opioid use disorder

Abstract: Buprenorphine is a highly effective but underutilized treatment for opioid use disorder (OUD). In April 2019, New Jersey Medicaid implemented a set of policies to improve buprenorphine access and use that eliminated prior authorizations, increased reimbursement for office-based addiction treatment, and established regional centers of excellence to support treatment providers. We evaluated policy-related changes in buprenorphine use and treatment duration among NJ Medicaid enrollees with OUD, as well as changes in access to treatment providers related to shifts in buprenorphine prescribing. Using autoregressive integrated moving average models in an interrupted time series framework, we assessed the association of the Medicaid policies with buprenorphine receipt, retention, and prescribing. We created monthly time series from 2016-2020 to examine trends in the 1) rate of buprenorphine receipt per 1,000 beneficiaries with OUD; 2) percentage of new buprenorphine episodes lasting 30+ days; and 3) rate of buprenorphine prescribing per 1,000 total Medicaid prescribers, overall and by specialty. The sample included 21,439 Medicaid beneficiaries with diagnosed OUD and 2,569 buprenorphine prescribers. Policy implementation was associated with a monthly increase in the number of patients who received buprenorphine of 1.45 per 1,000 enrollees (95% CI, 1.05 to 1.86), more than doubling the pre-policy trend. However, the monthly trend in the percentage of enrollees with new buprenorphine episodes who were retained for 30 or more days decreased following implementation (-0.17%; 95% CI, -0.25, -0.08). Policy implementation was also associated with increases in the number of buprenorphine prescribers at the time of implementation (1.57 per 1,000 total prescribers, 95% CI, 0.23 to 2.92) and over time in the post-policy period (0.38; 95% CI, 0.29 to 0.48). Estimates were similar across provider specialties, but increases were most pronounced among primary care and emergency medicine physicians. Overall, the findings indicate that NJ Medicaid policies expanded buprenorphine access for OUD treatment, particularly in general medical and acute care settings. However, the decrease in treatment episodes lasting 30 or more days indicates that retention on buprenorphine remains a challenge and highlights the need for further research on effective strategies to improve treatment continuity in conjunction with continued initiatives to increase treatment uptake.

Relevance to contemporary health policy, conference theme, and diversity mission: This study uses complete and current state-level administrative health care data (NJ Medicaid claims), comprising a priority group for efforts to address the ongoing overdose epidemic. With the goal of generating evidence on policy effectiveness, the findings are shared with state Medicaid partners to inform evolving programs, demonstrating the value of data analysis for influencing uptake of evidence-based policies. The first and second authors are PhD students in the Schools of Social Work (Treitler) and Public Health (Nowels) at Rutgers University and would benefit from attending this conference to further develop methodological skills needed to generate rigorous evidence to inform policy and practice.

Opioid use disorder

Medication for addiction treatment

Medication for opioid use disorder

Buprenorphine

Retention

Medicaid policy 

Mid-Level

Knowledge

International Conference on Health Policy Statistics 2023