Department of Pharmacy Practice and Science, University of Kentucky, Lexington.
Institute for Biomedical Informatics, University of Kentucky College of Medicine, Lexington.
JAMA Health Forum. 2024 May 3;5(5):e241077. doi: 10.1001/jamahealthforum.2024.1077.
Controlled substances have regulatory requirements under the US Federal Controlled Substance Act that must be met before pharmacies can stock and dispense them. However, emerging evidence suggests there are pharmacy-level barriers in access to buprenorphine for treatment for opioid use disorder even among pharmacies that dispense other opioids.
To estimate the proportion of Medicaid-participating community retail pharmacies that dispense buprenorphine, out of Medicaid-participating community retail pharmacies that dispense other opioids and assess if the proportion dispensing buprenorphine varies by Medicaid patient volume or rural-urban location.
DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study included Medicaid pharmacy claims (2016-2019) data from 6 states (Kentucky, Maine, North Carolina, Pennsylvania, Virginia, West Virginia) participating in the Medicaid Outcomes Distributed Research Network (MODRN). Community retail pharmacies serving Medicaid-enrolled patients were included, mail-order pharmacies were excluded. Analyses were conducted from September 2022 to August 2023.
The proportion of pharmacies dispensing buprenorphine approved for opioid use disorder among pharmacies dispensing an opioid analgesic or buprenorphine prescription to at least 1 Medicaid enrollee in each state. Pharmacies were categorized by median Medicaid patient volume (by state and year) and rurality (urban vs rural location according to zip code).
In 2016, 72.0% (95% CI, 70.9%-73.0%) of the 7038 pharmacies that dispensed opioids also dispensed buprenorphine to Medicaid enrollees, increasing to 80.4% (95% CI, 79.5%-81.3%) of 7437 pharmacies in 2019. States varied in the percent of pharmacies dispensing buprenorphine in Medicaid (range, 73.8%-96.4%), with significant differences between several states found in 2019 (χ2 P < .05), when states were most similar in the percent of pharmacies dispensing buprenorphine. A lower percent of pharmacies with Medicaid patient volume below the median dispensed buprenorphine (69.1% vs 91.7% in 2019), compared with pharmacies with above-median patient volume (χ2 P < .001).
In this serial cross-sectional study of Medicaid-participating pharmacies, buprenorphine was not accessible in up to 20% of community retail pharmacies, presenting pharmacy-level barriers to patients with Medicaid seeking buprenorphine treatment. That some pharmacies dispensed opioid analgesics but not buprenorphine suggests that factors other than compliance with the Controlled Substance Act influence pharmacy dispensing decisions.
受美国联邦管制物质法案的监管要求限制，药店在储备和分发管制物质之前必须满足这些要求。然而，新出现的证据表明，即使在分发其他阿片类药物的药店中，也存在获得治疗阿片类药物使用障碍的丁丙诺啡的药房层面障碍。
估计参与医疗补助计划的社区零售药店中，有多少药店分发丁丙诺啡，这些药店分发其他阿片类药物，并评估在参与医疗补助计划的患者数量或城乡位置方面，分发丁丙诺啡的比例是否存在差异。
设计、设置和参与者：本系列横断面研究包括来自参与医疗补助计划结果分布式研究网络（MODRN）的 6 个州（肯塔基州、缅因州、北卡罗来纳州、宾夕法尼亚州、弗吉尼亚州和西弗吉尼亚州）的医疗补助计划药房索赔数据（2016-2019 年）。包括为参与医疗补助计划的患者提供服务的社区零售药店，不包括邮购药店。分析于 2022 年 9 月至 2023 年 8 月进行。
在每个州，向至少一名医疗补助计划参保者分发阿片类镇痛药或丁丙诺啡处方的药店中，分发阿片类药物使用障碍治疗批准的丁丙诺啡的药店比例。根据每个州和年份的医疗补助计划参保者中位数（按州和年份）和农村地区（根据邮政编码的城乡位置）对药店进行分类。
2016 年，72.0%（95%置信区间，70.9%-73.0%）的分发阿片类药物的 7038 家药店也向医疗补助计划参保者分发了丁丙诺啡，到 2019 年，这一比例增加到 7437 家药店的 80.4%（95%置信区间，79.5%-81.3%）。各州之间分发丁丙诺啡的药店比例存在差异（范围为 73.8%-96.4%），在 2019 年发现了几个州之间存在显著差异（χ2 P <.05），当时各州分发丁丙诺啡的药店比例最为相似。患者人数低于中位数的药店分发丁丙诺啡的比例较低（2019 年为 69.1%，而高于中位数的为 91.7%）（χ2 P <.001）。
在这项对参与医疗补助计划的药店的系列横断面研究中，多达 20%的社区零售药店无法获得丁丙诺啡，这给寻求丁丙诺啡治疗的有医疗补助计划的患者带来了药房层面的障碍。一些药店分发阿片类镇痛药但不分发丁丙诺啡表明，影响药店配药决策的因素不仅仅是遵守《管制物质法》。
