State Policies and Buprenorphine Prescribing by Nurse Practitioners and Physician Assistants

Harrison, Jordan; Kerber, Rose; Andraka‐Christou, Barbara; Sorbero, Mark J.; Stein, Bradley D.

doi:10.1177/10775587221086489

Cited by 8 publications

(7 citation statements)

References 41 publications

(54 reference statements)

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“…Medicaid remains the predominant payer for OUD treatment . Studies have found an association between Medicaid expansion and Medicaid coverage of buprenorphine and increases in the number of buprenorphine-waivered prescribers, buprenorphine receipt among Medicaid-enrollees in the year after expansion, more dispensed buprenorphine prescriptions written by nurse practitioners and physician assistants, and fewer overdose deaths . In our analyses, we did not find Medicaid coverage for buprenorphine treatment or Medicaid expansion to be associated with buprenorphine treatment per capita.…”

Section: Discussioncontrasting

confidence: 77%

Association of Selected State Policies and Requirements for Buprenorphine Treatment With Per Capita Months of Treatment

et al. 2023

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ImportanceExpanding the use of buprenorphine for treating opioid use disorder is a critical component of the US response to the opioid crisis, but few studies have examined how state policies are associated with buprenorphine dispensing.ObjectiveTo examine the association of 6 selected state policies with the rate of individuals receiving buprenorphine per 1000 county residents.Design, Setting, and ParticipantsThis cross-sectional study used 2006 to 2018 US retail pharmacy claims data for individuals dispensed buprenorphine formulations indicated for treating opioid use disorder.ExposuresState implementation of policies requiring additional education for buprenorphine prescribers beyond waiver training, continuing medical education related to substance misuse and addiction, Medicaid coverage of buprenorphine, Medicaid expansion, mandatory prescriber use of prescription drug monitoring programs, and pain management clinic laws were examined.Main Outcomes and MeasuresThe main outcome was buprenorphine treatment months per 1000 county residents as measured using multivariable longitudinal models. Statistical analyses were conducted from September 1, 2021, through April 30, 2022, with revised analyses conducted through February 28, 2023.ResultsThe mean (SD) number of months of buprenorphine treatment per 1000 persons nationally increased steadily from 1.47 (0.04) in 2006 to 22.80 (0.55) in 2018. Requiring that buprenorphine prescribers receive additional education beyond that required to obtain the federal X-waiver was associated with significant increases in the number of months of buprenorphine treatment per 1000 population in the 5 years following implementation of the requirement (from 8.51 [95% CI, 2.36-14.64] months in year 1 to 14.43 [95% CI, 2.61-26.26] months in year 5). Requiring continuing medical education for physician licensure related to substance misuse or addiction was associated with significant increases in buprenorphine treatment per 1000 population in each of the 5 years following policy implementation (from 7.01 [95% CI, 3.17-10.86] months in the first year to 11.43 [95% CI, 0.61-22.25] months in the fifth year). None of the other policies examined was associated with a significant change in buprenorphine months of treatment per 1000 county residents.Conclusions and RelevanceIn this cross-sectional study of US pharmacy claims, state-mandated educational requirements beyond the initial training required to prescribe buprenorphine were associated with increased buprenorphine use over time. The findings suggest requiring education for buprenorphine prescribers and training in substance use disorder treatment for all controlled substance prescribers as an actionable proposal for increasing buprenorphine use, ultimately serving more patients. No single policy lever can ensure adequate buprenorphine supply; however, policy maker attention to the benefits of enhancing clinician education and knowledge may help to expand buprenorphine access.

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Section: Discussioncontrasting

confidence: 77%

Association of Selected State Policies and Requirements for Buprenorphine Treatment With Per Capita Months of Treatment

et al. 2023

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“…A study of data from 2017 to 2018 found the vast majority of buprenorphine-prescribing clinicians treat fewer than 3. a. The licensee shall ensure that the patient is seen: (i) No later than ten (10) days after induction and then at intervals of no more than ten (10) days for the first month after induction; and (ii) At intervals of no more than fourteen ( 14) days for the second month after induction. b.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 There have been relatively few studies describing state variation in laws regulating office-based buprenorphine treatment (OBBT), despite evidence that state laws related to buprenorphine may influence buprenorphine prescribing. 10,11 One study describing the evolution of state laws regulating buprenorphine from 2005 to 2019 found that several states had imposed counseling, dosage, or visit frequency requirements. 12 That study only included laws applicable to all payors (eg, excluded laws only applicable to Medicaid providers.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of State Office-Based Buprenorphine Treatment Laws Effective During 2022: Counseling, Dosage, and Visit Frequency Requirements

Andraka-Christou,

Golan,

Williams

et al. 2024

Substance Use & Addiction Journal

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Background: Buprenorphine is among the most effective treatments for opioid use disorder. Even though the federal government recently eliminated the waiver requirement and patient limits applicable to office-based buprenorphine treatment (OBBT), among other settings, some states may still have policies imposing requirements on OBBT providers not required by federal law. Methods: We collected statutes and regulations from 50 US states and the District of Columbia (ie, 51 jurisdictions) between August 11 and November 30, 2022 using the Nexis Uni legal database and search terms related to OBBT counseling, dosage, and/or frequency of visits. We then used template analysis, a mixed deductive-inductive qualitative method, to analyze legal content. Results: Ten jurisdictions (20%) in 2022 had an OBBT counseling, dosage, and/or visit frequency requirement. Four jurisdictions had at least one law in each OBBT policy category examined. One-fifth of jurisdictions have OBBT policies not required under federal law. Five of these jurisdictions are among those with the highest overdose death rates per capita, according to publicly available data from 2021. Some OBBT requirements could potentially limit clinician interest in offering buprenorphine treatment or result in inadequate care (eg, if dosage limitations are too low.) Conclusions: Even though a federal waiver is no longer required for OBBT, our results suggests that at least some jurisdictions have other OBBT requirements, such as counseling, dosage, and/or frequency requirements. Given the severity of the ongoing opioid overdose crisis, policymakers should carefully consider the extent to which OBBT requirements are evidence based.

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“…Prior authorizations are a commonly cited barrier to buprenorphine prescribing, and eliminating prior authorization requirements has been shown to increase treatment access . Efforts like New Jersey’s OBAT program, which increase reimbursement and assist prescribers in addressing patients’ psychosocial needs, have similarly found success in expanding availability and utilization of treatment services . Support for buprenorphine prescribers like that provided by New Jersey’s 2 MAT COEs, can also increase buprenorphine prescribing .…”

Section: Discussionmentioning

confidence: 99%

“… 31 , 32 Efforts like New Jersey’s OBAT program, which increase reimbursement and assist prescribers in addressing patients’ psychosocial needs, have similarly found success in expanding availability and utilization of treatment services. 33 , 34 , 35 Support for buprenorphine prescribers like that provided by New Jersey’s 2 MAT COEs, can also increase buprenorphine prescribing. 35 , 36 , 37 Importantly, synergistic factors unique to New Jersey may account for the changes in buprenorphine use and prescribing observed in this study.…”

Section: Discussionmentioning

confidence: 99%

Buprenorphine Utilization and Prescribing Among New Jersey Medicaid Beneficiaries After Adoption of Initiatives Designed to Improve Treatment Access

et al. 2023

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ImportanceBuprenorphine is underutilized as a treatment for opioid use disorder (OUD); state policies may improve buprenorphine access and utilization.ObjectiveTo assess buprenorphine prescribing trends following New Jersey Medicaid initiatives designed to improve access.Design, Setting, and ParticipantsThis cross-sectional interrupted time series analysis included New Jersey Medicaid beneficiaries who were prescribed buprenorphine and had 12 months continuous Medicaid enrollment, OUD diagnosis, and no Medicare dual eligibility, as well as physician or advanced practitioners who prescribed buprenorphine to Medicaid beneficiaries. The study used Medicaid claims data from 2017 to 2021.ExposureImplementation of New Jersey Medicaid initiatives in 2019 that removed prior authorizations, increased reimbursement for office-based OUD treatment, and established regional Centers of Excellence.Main Outcomes and MeasuresRate of buprenorphine receipt per 1000 beneficiaries with OUD; percentage of new buprenorphine episodes lasting at least 180 days; buprenorphine prescribing rate per 1000 Medicaid prescribers, overall and by specialty.ResultsOf 101 423 Medicaid beneficiaries (mean [SD] age, 41.0 [11.6] years; 54 726 [54.0%] male; 30 071 [29.6%] Black, 10 143 [10.0%] Hispanic, and 51 238 [50.5%] White), 20 090 filled at least 1 prescription for buprenorphine from 1788 prescribers. Policy implementation was associated with an inflection point in buprenorphine prescribing trend; after implementation, the trend increased by 36%, from 1.29 (95% CI, 1.02-1.56) prescriptions per 1000 beneficiaries with OUD to 1.76 (95% CI, 1.46-2.06) prescriptions per 1000 beneficiaries with OUD. Among beneficiaries with new buprenorphine episodes, the percentage retained for at least 180 days was stable before and after initiatives were implemented. The initiatives were associated with an increase in the growth rate of buprenorphine prescribers (0.43 per 1000 prescribers; 95% CI, 0.34 to 0.51 per 1000 prescribers). Trends were similar across specialties, but increases were most pronounced among primary care and emergency medicine physicians (eg, primary care: 0.42 per 1000 prescribers; 95% CI, 0.32-0.53 per 1000 prescribers). Advanced practitioners accounted for a growing percentage of buprenorphine prescribers, with a monthly increase of 0.42 per 1000 prescribers (95% CI, 0.32-0.52 per 1000 prescribers). A secondary analysis to test for changes associated with non–state-specific secular trends in prescribing found that quarterly trends in buprenorphine prescriptions increased in New Jersey relative to all other states following initiative implementation.Conclusions and RelevanceIn this cross-sectional study of state-level New Jersey Medicaid initiatives designed to expand buprenorphine access, implementation was associated with an upward trend in buprenorphine prescribing and receipt. No change was observed in the percentage of new buprenorphine treatment episodes lasting 180 or more days, indicating that retention remains a challenge. Findings support implementation of similar initiatives but highlight the need for efforts to support long-term retention.

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State Policies and Buprenorphine Prescribing by Nurse Practitioners and Physician Assistants

Cited by 8 publications

References 41 publications

Association of Selected State Policies and Requirements for Buprenorphine Treatment With Per Capita Months of Treatment

Association of Selected State Policies and Requirements for Buprenorphine Treatment With Per Capita Months of Treatment

A Systematic Review of State Office-Based Buprenorphine Treatment Laws Effective During 2022: Counseling, Dosage, and Visit Frequency Requirements

Buprenorphine Utilization and Prescribing Among New Jersey Medicaid Beneficiaries After Adoption of Initiatives Designed to Improve Treatment Access

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