Medicaid Unwinding and Changes in Buprenorphine Dispensing

Published in JAMA Network Open. Here is a link to the article.

Regenstrief Institute authors: Kosali Simon, PhD, M.A.

A new national study has found that the Medicaid unwinding process following the end of the continuous enrollment provision was associated with significant disruptions in access to buprenorphine therapy among adult Medicaid beneficiaries. Utilizing data from over 750,000 person-years across 46 states and the District of Columbia, the analysis compared states with the highest versus lowest drops in Medicaid enrollment between 2023 and the baseline.

The findings indicate that patients in states with the largest disenrollment saw a reduction in the number of days with active buprenorphine prescriptions and were more likely to have no active prescription at all. These patients were also more likely to shift to private insurance or pay out-of-pocket for treatment, reflecting increased financial barriers to care. Notably, patients with less consistent buprenorphine use prior to disenrollment experienced the sharpest declines in therapy continuation.

The data suggest that Medicaid disenrollment may have limited access to this critical medication for opioid use disorder, potentially worsening outcomes amid the ongoing opioid epidemic. The study also highlights that patients previously using only branded buprenorphine products were disproportionately affected, likely due to higher costs.

While limitations include the inability to directly identify individuals disenrolled from Medicaid, the consistent trends across multiple analyses point to a clear association between coverage loss and therapy disruption. The results underscore the need for policy interventions to maintain continuity of care during insurance transitions, particularly for populations at risk of opioid-related harm.

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