Impact of Kentucky Medicaid Prior Authorization Removal on Dispensing and Continuity of Buprenorphine for the Treatment of Opioid Use Disorder

Background: While aimed at ensuring safe medication use, prior authorization (PA) requirements linked to medication for opioid use disorder (MOUD) have been increasingly cited as barriers to care. Removal of these requirements for buprenorphine-naloxone was found to be associated with increased medication use and decreased opioid use disorder (OUD)-related inpatient admissions and emergency department visits. Kentucky Medicaid removed PA requirements for transmucosal buprenorphine on February 1, 2019.

Objectives: This study aims to identify changes in trend regarding dispensing and continuity of buprenorphine for treatment of OUD following the removal of transmucosal buprenorphine PA requirements for Kentucky Medicaid enrollees.

Methods: Kentucky Prescription Drug Monitoring Program (PDMP) dispensing records, ranging from July 1, 2017 through February 29, 2020, were used to identify enrollees aged 18 or older with a dispensed prescription for any buprenorphine product approved by the US Food and Drug Administration (FDA) for treatment of OUD. Segmented regression analysis was used for statistical modeling of an interrupted time series design to describe changes in 1) the monthly number of individuals receiving buprenorphine for OUD and 2) the monthly proportion of individuals receiving buprenorphine for OUD retained in treatment at least 180 days. Individuals with an allowable gap of ≤7 days in treatment were considered retained. The index date for the model was February 1, 2019 (the effective date of PA removal).

Results: Monthly number of patients receiving buprenorphine during the study period ranged from 24,401 to 37,579. Prior to PA removal, the number of patients receiving buprenorphine was increasing at an estimated rate of 369.12 (95% CI 348.08–390.15) persons per month. Following PA removal, no significant immediate or sustained change in trend was observed, indicating continued sustainment of the increasing pre-policy trend. Additional analyses are in progress to assess potential changes in continuity of buprenorphine therapy.

Conclusions: Following removal of transmucosal buprenorphine PA requirements for Kentucky Medicaid enrollees, the trend in number of patients receiving buprenorphine therapy was sustained. Further research is underway to evaluate impacts of this change on continuity of therapy.