Reforms to New Jersey’s Medicaid program have spurred continued increases in buprenorphine prescriptions to treat opioid addiction, according to a Rutgers analysis.
Although drugs like buprenorphine effectively combat opioid addiction, nationwide, fewer than 30 percent of potential users receive them. New Jersey sought to increase prescription numbers with three Medicaid reforms that went into effect in 2019. The reforms:
- Removal of prior authorization requirements for buprenorphine prescriptions
- Increased reimbursement rates for in-clinic opioid addiction treatment
- Establish regional centers of excellence for addiction treatment
Medicaid records showed steady increases in buprenorphine prescriptions prior to 2019, but the growth rate increased by 36 percent after the reforms took effect, and this increased growth rate continued through the end of the study period in December 2020.
A similar trend affected caregiver behavior. The percentage of caregivers prescribing buprenorphine was rising before the reforms went into effect, but increased faster after they were implemented.
The analysis reported that New Jersey also experienced faster growth in buprenorphine prescriptions for Medicaid patients compared to other states, a strong indication that the boosts stemmed from state reforms rather than some unrelated nationwide trend.
The only disappointment came from the study’s measurement of long-term use. The percentage of buprenorphine prescriptions that remained active for more than 180 days did not increase during the study period.
said Peter Trettler, research project director at the Rutgers Institute of Health, Healthcare Policy, and Aging Research and lead author of the analysis published in JAMA Network is open. “However, our analysis indicates that these reforms may have reached that point years earlier than we did under previous policies.”
buprenorphine -; A prescription pill sold once daily in the United States as Suboxone, Zubsolv, and Sublocade – ; It works in two ways. First, it binds to the same brain cells as drugs like opium, heroin, morphine, oxycodone, and fentanyl. Once in place, those other drugs struggle to dislodge them, binding to target cells and producing addictive highs. Second, it induces a milder effect that reduces cravings for those other medications and prevents withdrawal symptoms.
Regulators once placed additional restrictions on buprenorphine prescriptions because they worried its effects on mood would create more addicts than it treats. These restrictions, Trettler said, have forced providers to justify each new buprenorphine prescription in detail and investigate providers who prescribed the drug “more often,” led many to avoid prescribing the drug at all. The treatment also reduced the availability of buprenorphine for poor patients.
Regulators have eased several restrictions on buprenorphine due to increasing opioid addiction. Recent research shows that buprenorphine is safer and more effective than previously thought. Reforms to Medicaid in New Jersey have lowered barriers to drug use among its patients.
They looked at the barriers to using a valuable drug in this particularly underserved patient population. They have removed many of the biggest obstacles. And the results so far indicate that they are getting the desired results.”
Peter Trettler, research project director at the Rutgers Institute of Health, Healthcare Policy, and Aging Research
In fact, the positive numbers seen in initiatives like that of Medicaid in New Jersey may finally affect the most important number of all: overdose deaths. After several decades of rapid increases, overdoses nationwide rose by only 500 in 2022.
The trend was better in New Jersey. Total overdose deaths decreased by 232 from 2021 to 2022, and were 93 fewer in the first three months of 2023 than in the first three months of 2022.
Treitler, P., et al. (2023) Buprenorphine use and prescribing among Medicaid beneficiaries in New Jersey after adoption of initiatives designed to improve access to treatment. JAMA Network is open. doi.org/10.1001/jamanetworkopen.2023.12030.