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Some states fund comparatively low percentage of buprenorphine costs

September 22, 2016
by Julie Miller, Editor in Chief
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The IMS Institute for Healthcare Informatics this week released research showing the average use of buprenorphine is 39 prescriptions per year per 1,000 in a population nationally, however, significant variations exist among states in how buprenorphine is prescribed and reimbursed.

For example, 68% of such prescriptions are paid by Medicaid in Vermont, while just 4% are paid by Medicaid in Mississippi.

Advocates for Opioid Recovery (AOR)—a new not-for-profit group led by civil rights advocate Van Jones, former Congressman Patrick J. Kennedy, and former Speaker of the House Newt Gingrich—funded the study. Gingrich recommended in a statement that governors investigate how their state Medicaid programs are covering opioid recovery treatment.

Who pays?

Researchers aimed to identify the trends in utilization of buprenorphine based on payer source. They found that:

  • Commercial insurance plans cover 57% of total buprenorphine prescriptions nationally;
  • Medicaid programs cover 24%;
  • Medicare Part D plans cover 7%; and
  • The remaining 11% of prescriptions are paid for in cash by patients.

Alabama, Florida, Mississippi and Utah are among the states with the most out-of-pocket payment for buprenorphine. In a statement, Kennedy commented that the payment variation among states “suggests inconsistent and suboptimal approaches in many parts of the country,” which he believes could also indicate parity law violations.

Additionally, IMS data shows the total number of retail prescriptions for buprenorphine increased from 8.2 million in 2012 to 12.5 million in 2016, but AOR notes that more recently, the growth year to year has actually slowed rather than accelerated. It remains to be seen whether new federal initiatives to increase the use of medication-assisted treatment will drive the growth trend in the coming years.