State Prior Authorization Prohibitions and Buprenorphine Retention Among Privately Insured Patients

Area of Science:

• Pharmacology
• Health Services Research
• Public Health Policy

Background:

• Buprenorphine is a key medication for treating opioid use disorder (OUD), but low treatment retention rates persist.
• Prior authorization (PA) is a significant barrier to buprenorphine access, leading many states to enact laws prohibiting its use for private insurance.

Purpose of the Study:

• To investigate the association between state-level prior authorization (PA) prohibitions and buprenorphine treatment retention.
• To determine if this association differs for branded versus generic buprenorphine formulations.

Main Methods:

• Cross-sectional study utilizing a difference-in-differences design with private insurance claims data from 49 states and DC.
• Included patients aged 18-64 initiating buprenorphine treatment between January 1, 2015, and June 1, 2022.
• Treatment retention was defined as an episode lasting 180 days or longer.

Main Results:

• The study included 22,946 patients, with 30.4% achieving 180-day treatment retention.
• Prior authorization prohibitions were not significantly associated with changes in overall buprenorphine treatment retention (P=.78).
• No significant associations were found between PA prohibitions and treatment retention for either branded or generic buprenorphine.

Conclusions:

• State laws prohibiting prior authorization for buprenorphine do not appear to significantly improve treatment retention among privately insured patients.
• Prior authorization prohibition alone may be insufficient to overcome barriers to sustained buprenorphine treatment.
• Further interventions are necessary to improve opioid use disorder treatment outcomes for privately insured individuals.