High-volume buprenorphine prescribers: Examining state policy contexts

Area of Science:

• Health Policy
• Substance Use Disorder Treatment
• Buprenorphine Prescribing

Background:

• Most buprenorphine patients rely on a few high-volume prescribers.
• Limited understanding exists regarding how state policies influence high-volume buprenorphine prescribing patterns.

Purpose of the Study:

• To examine the association between four state policies and high-volume buprenorphine prescribing.
• To quantify the impact of specific policies on the share of clinicians prescribing buprenorphine to a high volume of patients.

Main Methods:

• Utilized IQVIA Real World Data (2009-2018) capturing ~90% of U.S. retail pharmacy transactions.
• Employed multivariable event-time linear probability models to assess policy impacts.
• Analyzed four state policies: mandatory behavioral health counseling, mandatory SUD CME, ACA Medicaid expansion, and mandatory PDMP laws.

Main Results:

• An increase in high-volume prescribers was observed over the study period.
• Mandatory behavioral health counseling was associated with a significant increase in high-volume prescribers.
• Mandatory PDMP laws correlated with a significant decrease in the share of high-volume prescribers.

Conclusions:

• The proportion of high-volume buprenorphine prescribers grew significantly from 2009-2018.
• State policies demonstrated differential effects on the growth patterns of high-volume prescribers.
• Findings highlight the influence of state-level regulations on buprenorphine prescribing dynamics.