Medicaid Expansion Improved Opioid Use Disorder Treatment

Under the Affordable Care Act (ACA), states can choose to expand their Medicaid programs to provide coverage for low-income individuals who meet less stringent federal income requirements. The federal government is responsible for providing additional funding to ensure these states are able to afford covering additional enrollees.

A study published by Medical Care discovered that Medicaid expansion states were more likely to have a significant increase in prescriptions for buprenorphine, which is commonly used to treat opioid misuse disorder. These findings also show the need for physicians who are able to prescribe the drug.

"Our findings suggest that Medicaid expansion has the potential to reduce the financial barriers to buprenorphine utilization and improve access to medication-assisted treatment of opioid use disorder," the authors wrote.

In the study, the authors examined the trends in buprenorphine prescriptions covered by Medicaid in states that did and did not expand their programs. Access to this drug is important for reducing use and aiding recovery among patients with opioid use disorder, which disproportionately affects low-income individuals.

In 2014, 26 states and the District of Columbia expanded their Medicaid programs. The authors discovered that these states saw an increase in Medicaid-covered buprenorphine prescriptions, while prescribing trends were not impacted in states that did not expand Medicaid or among those that expanded after 2014, according to the study.

After accounting for other factors, Medicaid expansion was linked to a 70% increase in buprenorphine prescriptions and a 50% increase in spending on the drug.

Additionally, whether the physician was actually allowed to prescribe the drug was an important factor to consider when studying access to treatment. Since buprenorphine is a controlled substance, there are federal regulations that dictate the physicians who can prescribe the drug and how many patients they treat.

For each 10% increase in physicians approved to treat up to 100 patients per year, there was an observed 45% increase in prescriptions, with a 31% increase in spending, according to the study. In areas with few approved providers, expansion did not impact buprenorphine prescribing.

Buprenorphine is a crucial factor involved with fighting the opioid epidemic. A lack of health insurance has been a significant treatment barrier in the past, but Medicaid expansion has the ability to increase buprenorphine among low-income individuals with high rates of opioid use disorder.

These findings show that Medicaid expansion states substantially increased buprenorphine access. As states implement additional measures to increase access to Medicaid and medication-assisted treatment, the authors expect additional improvements.

The authors indicated that physician prescribing capacity plays a critical role in improving treatment for opioid use disorder, since states with expanded Medicaid without an increase in prescribers was not observed to increase prescriptions.

“Sufficient physician prescribing capacity is necessary for ensuring that Medicaid expansion achieves its full potential in improving buprenorphine utilization,” the study concluded.