Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville.
Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville.
JAMA Health Forum. 2022 Jun 24;3(6):e221757. doi: 10.1001/jamahealthforum.2022.1757. eCollection 2022 Jun.
State Medicaid programs have implemented initiatives to expand treatment coverage for opioid use disorder (OUD); however, some Medicaid programs still require prior authorizations (PAs) for filling buprenorphine prescriptions.
To evaluate the changes in buprenorphine use for OUD among Medicaid enrollees in states that completely removed buprenorphine PA requirements.
This retrospective cross-sectional study analyzed the immediate and trend changes on buprenorphine use during 2013 to 2020 associated with removal of PA requirements using a controlled interrupted time series analysis to account for autocorrelation. Data were collected from Medicaid State Drug Utilization Data for 2 states (California and Illinois) that completely removed a buprenorphine PA during the study period, and buprenorphine prescriptions for OUD treatment were identified among Medicaid enrollees.
Quarterly total number of buprenorphine prescriptions for each state was calculated, and stratification analyses were conducted by dosage form (films and tablets).
Among the 2 state Medicaid programs (California and Illinois) that removed buprenorphine PAs, there was a total of 702 643 and 415 115 eligible buprenorphine prescription claims, respectively. After removing PA requirements for buprenorphine, there was an immediate increase that was not statistically significant (rate ratio [RR], 1.11; 95% CI, 0.76-1.61) in the number of all buprenorphine prescriptions in California and a statistically significant increase (RR, 6.99; 95% CI, 4.67-10.47) in the number of all buprenorphine prescriptions in Illinois relative to the change in the control states (Alabama, Florida, Idaho, Kansas, Mississippi, Nevada, South Dakota, and Wyoming). Additionally, there was a statistically significant decreasing trend in the number of all buprenorphine prescriptions in California (RR, 0.88; 95% CI, 0.82-0.94) and a statistically significant increasing trend in Illinois (RR, 1.11; 95% CI, 1.05-1.19) relative to the trend in control states.
In this cross-sectional study, removal of buprenorphine PA requirements was associated with a statistically significant increase in the number of buprenorphine prescription fills among Medicaid populations in 1 of the 2 included states.
州医疗补助计划已采取举措扩大阿片类药物使用障碍（OUD）的治疗覆盖范围；然而，一些医疗补助计划仍然要求对丁丙诺啡处方进行事先授权（PA）。
评估在完全取消丁丙诺啡 PA 要求的州中，医疗补助受助人中丁丙诺啡治疗 OUD 的使用变化情况。
设计、设定和参与者：本回顾性横截面研究使用控制中断时间序列分析来评估 2013 年至 2020 年期间与取消 PA 要求相关的丁丙诺啡使用的即时和趋势变化，以考虑自相关。数据来自 Medicaid 州药物利用数据，涉及 2 个州（加利福尼亚州和伊利诺伊州），在研究期间完全取消了丁丙诺啡的 PA，并且在医疗补助受助人中确定了丁丙诺啡治疗 OUD 的处方。
计算了每个州的丁丙诺啡处方总数，并按剂型（薄膜和片剂）进行分层分析。
在取消丁丙诺啡 PA 的 2 个州医疗补助计划（加利福尼亚州和伊利诺伊州）中，分别有 702643 和 415115 份符合条件的丁丙诺啡处方。在取消丁丙诺啡 PA 要求后，加利福尼亚州的丁丙诺啡处方数量立即增加，但无统计学意义（比率比 [RR]，1.11；95%CI，0.76-1.61），伊利诺伊州的丁丙诺啡处方数量则有统计学意义的增加（RR，6.99；95%CI，4.67-10.47），而对照组（阿拉巴马州、佛罗里达州、爱达荷州、堪萨斯州、密西西比州、内华达州、南达科他州和怀俄明州）的变化。此外，加利福尼亚州的丁丙诺啡处方数量呈统计学意义的下降趋势（RR，0.88；95%CI，0.82-0.94），伊利诺伊州呈统计学意义的上升趋势（RR，1.11；95%CI，1.05-1.19），而对照组的趋势则相反。
在这项横截面研究中，取消丁丙诺啡 PA 要求与 2 个纳入州中的 1 个州的医疗补助人群中丁丙诺啡处方数量的统计学显著增加相关。
