While insurance coverage of some forms of buprenorphine has improved over the years, researchers say coverage of new, more effective forms of the medication is lacking.
By Danielle Hendrix ’15 | July 12, 2023
In 2021, more people died from opioid overdoses in the U.S. than any other year in history, according to data from the U.S. Centers for Disease Control and Prevention.
However, a new University of Central Florida study recently published in Health Affairs shows that one of the most effective medications for treating opioid addiction is one of the least covered by insurance plans often used by patients with substance use disorder.
Researchers found that although most plans covered the immediate-release sublingual form of buprenorphine, extended-release buprenorphine injections were covered by less than half of commercial plans and less than a fifth of Medicare Advantage Plans. Furthermore, while most Medicaid plans did cover it, more than a third presented a barrier by requiring prior authorization before prescription.
The study’s lead author, Barbara “Basia” Andraka-Christou, says her key passion in research is trying to understand how to expand access to these life-saving treatments.
“Approximately 20% of people actually use buprenorphine or another similar medication called methadone for treatment of opioid-use disorder,” she says. “Most people don’t get any treatment, or if they do get treatment, they’re getting something that’s less effective. Unfortunately, there have been a lot of barriers to accessing it, and some of those have been either lack of insurance coverage or various prior-authorization requirements.”
Buprenorphine can be prescribed by any clinician licensed by the Drug Enforcement Administration and comes in two overall forms: an oral immediate release version that is taken daily or a monthly extended-release intramuscular injection. Since some of the oral versions of the medication are available in generic form, they tend to be the cheaper option. The injection is newer and still under patent, making it the more expensive option.
How the Research Was Performed
Andraka-Christou, an associate professor in the School of Global Health Management and Informatics at UCF, teamed up with Thuy Nguyen from the University of Michigan, W. David Bradford from the University of Georgia and Kosali Simon from Indiana University to examine Medicaid, Medicare Advantage and commercial insurance formulary files to compare insurance-imposed restrictions for buprenorphine from 2017-21.
They studied factors like insurance coverage, prior-authorization requirements, and other potential access barriers like step therapy and quantitative limits across commercial providers, Medicaid, and Medicare.