The disparity in access to buprenorphine, an essential medication for opioid use disorder, persists among Medicaid-participating community retail pharmacies despite some improvements. A study examining the period between 2016 and 2019 reveals that while the overall availability of buprenorphine has increased, significant barriers remain, particularly in pharmacies serving fewer Medicaid patients and in certain states. These findings highlight the need for targeted interventions to ensure equitable access to treatment for opioid use disorder.
Study Design and Methodology
This serial cross-sectional study analyzed Medicaid pharmacy claims data from 2016 to 2019 across six states: Kentucky, Maine, North Carolina, Pennsylvania, Virginia, and West Virginia. The study focused on community retail pharmacies serving Medicaid-enrolled patients, excluding mail-order pharmacies. The primary aim was to estimate the proportion of these pharmacies that dispense buprenorphine compared to those that dispense other opioids. The research also examined differences based on Medicaid patient volume and the rural-urban location of the pharmacies.
Data collection and analysis spanned from September 2022 to August 2023, with pharmacies categorized by median Medicaid patient volume and their urban or rural zip code locations. The study’s main outcomes measured the proportion of pharmacies dispensing buprenorphine among those dispensing at least one opioid analgesic or buprenorphine prescription to Medicaid enrollees.
Key Findings
In 2016, 72.0% of the 7038 pharmacies that dispensed opioids also dispensed buprenorphine, increasing to 80.4% of 7437 pharmacies by 2019. There was notable variation among states, with the percentage of pharmacies dispensing buprenorphine ranging from 73.8% to 96.4% in 2019. Significant differences were observed between states, especially in 2019 when states were most similar in the proportion of pharmacies dispensing buprenorphine.
The study also found that pharmacies with below-median Medicaid patient volume were less likely to dispense buprenorphine compared to those with above-median patient volume (69.1% vs. 91.7% in 2019). This disparity underscores the role of pharmacy-level factors beyond regulatory compliance in influencing the availability of buprenorphine.
Actionable Insights
– Pharmacies serving a higher volume of Medicaid patients are more likely to dispense buprenorphine.
– Significant state-by-state variations suggest targeted state-level interventions could improve access.
– Non-compliance factors, including business decisions and stigma, may affect dispensing practices.
– Enhancing buprenorphine access in rural areas requires specific strategies tailored to these communities.
In conclusion, while progress has been made, up to 20% of community retail pharmacies still do not provide buprenorphine, presenting a barrier for Medicaid patients seeking treatment for opioid use disorder. The tendency for some pharmacies to dispense opioid analgesics but not buprenorphine suggests that additional factors, beyond regulatory compliance, are at play in dispensing decisions.
Original Article: JAMA Health Forum. 2024 May 3;5(5):e241077. doi: 10.1001/jamahealthforum.2024.1077.
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