As Medicaid’s continuous enrollment policy ended in March 2023, millions across the U.S. faced disenrollment, leading to concerns regarding access to essential treatments, including buprenorphine for opioid use disorder. During this unsettling period, North Carolina took a significant step on December 1, 2023, expanding Medicaid under the Patient Protection and Affordable Care Act (ACA) to cover low-income adults. This study assesses the impact of this expansion on the prescription patterns of buprenorphine, a critical treatment for managing opioid addiction, providing insights into the effects of policy changes on healthcare delivery.
Study Overview and Methodology
The investigation employed a difference-in-differences analysis utilizing the IQVIA Longitudinal Prescription Database, which records 92% of prescriptions in the U.S. The study focused on adults in North and South Carolina, a state that has not embraced Medicaid expansion, thus serving as a control group. Researchers analyzed data from individuals prescribed Medicaid-paid buprenorphine between March and May 2023, with preintervention data spanning from June to November 2023, and postintervention covering December 2023 to December 2024.
Key Findings and Statistical Outcomes
The analysis incorporated 286,216 person-months from 15,064 individuals, with data revealing a 1.6 percentage point increase in active buprenorphine prescriptions in North Carolina post-Medicaid expansion. Notably, this expansion correlated with a 7.4 percentage point rise in Medicaid-funded prescriptions, whereas private and cash-paid prescriptions saw declines of 4.1 and 1.4 percentage points, respectively. A drop of 11.3 and 11.2 percentage points in buprenorphine prescriptions was observed in both states prior to North Carolina’s policy change.
Analysis suggests several inferences about the studied period and policy:
- The Medicaid expansion’s timing may have alleviated some healthcare access issues caused by prior policy adjustments.
- A tangible shift towards Medicaid-funded prescriptions occurred, particularly affecting those previously reliant on private or cash-pay options.
- The expansion’s benefits primarily impacted low-income adults, indicating a targeted influence of policy changes on vulnerable populations.
This cross-sectional study highlights the role of Medicaid expansion in moderating the adverse effects of policy shifts on buprenorphine dispensing. By enhancing access to treatment through broader Medicaid coverage, North Carolina’s healthcare landscape exhibited resilience in the face of regulatory transitions. For stakeholders and policymakers, this underscores the importance of adaptive strategies to maintain access to essential healthcare services amid policy evolutions. These findings emphasize the significance of Medicaid’s role in supporting low-income individuals with critical health needs, offering a blueprint for other states deliberating Medicaid expansion. As healthcare policies continue to evolve, vigilance in monitoring the longitudinal impacts of such expansions remains crucial for fostering robust healthcare systems and ensuring the well-being of affected populations.
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