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Impact of Medicaid Expansion on Medicaid-covered Utilization of Buprenorphine for Opioid Use Disorder Treatment

Wen, Hefei PhD; Hockenberry, Jason M. PhD; Borders, Tyrone F. PhD; Druss, Benjamin G. MD, MPH

doi: 10.1097/MLR.0000000000000703
Original Articles

Background: Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment for opioid use disorder.

Objective: To examine whether Medicaid expansion and physician prescribing capacity may have impacted buprenorphine utilization covered by Medicaid.

Research Design: We used a quasi experimental difference-in-differences design to compare the pre-post changes in Medicaid-covered buprenorphine prescriptions and buprenorphine spending between the 26 states that implemented Medicaid expansions under the Affordable Care Act in 2014 and those that did not.

Subjects: All Medicaid enrollees in the expansion states and the nonexpansion and late-expansion states.

Measures: Quarterly Medicaid prescriptions for buprenorphine and spending on buprenorphine from the Centers for Medicare and Medicaid Services Medicaid Drug Utilization files 2011 to 2014.

Results: State implementation of Medicaid expansions in 2014 was associated with a 70% increase (P<0.05) in Medicaid-covered buprenorphine prescriptions and a 50% increase (P<0.05) in buprenorphine spending. Physician prescribing capacity was also associated with increased buprenorphine utilization.

Conclusions: Medicaid expansion has the potential to reduce the financial barriers to buprenorphine utilization and improve access to medication-assisted treatment of opioid use disorder. Active physician participation in the provision of buprenorphine is needed for ensuring that Medicaid expansion achieves its full potential in improving treatment access.

*Department of Health Management & Policy, University of Kentucky College of Public Health, Lexington, KY

Department of Health Policy & Management, Emory University Rollins School of Public Health, Atlanta, GA

The authors declare no conflict of interest.

Reprints: Hefei Wen, PhD, Department of Health Management & Policy, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536. E-mail:

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