Prior Authorization Policies Are Associated With Shorter Duration of Buprenorphine Treatment

Buprenorphine is a very effective treatment for opioid use disorder and longer duration of treatment with buprenorphine improves outcomes. Despite its effectiveness and relative safety, many insurers have prior authorization policies that create barriers to buprenorphine receipt. Researchers used 2006–2014 Medicaid claims data to investigate the association between prior authorization requirements and buprenorphine treatment duration of ≥180 days, as well as concurrent prescribing of benzodiazepines and opioid analgesics.

• During the study period, there were 294,031 buprenorphine treatment episodes that met study inclusion criteria. Nearly half had a duration of ≥180 days (47%). Most of these episodes did not include receipt of concurrent prescriptions for benzodiazepines (75%) or opioid analgesics (76%).
• Prior authorization requirement was associated with significantly fewer treatment episodes of ≥180 days, with an 11% reduction in year 1 of policy implementation, 9% reduction in year 2, 15% reduction in year 3, and 10% reduction in year 4.
• Prior authorization policies were not associated with concurrent prescribing of benzodiazepines or opioid analgesics.

Comments: Prior authorization policies are ostensibly intended to improve quality of care and prevent unsafe practices. However, these policies create more work for clinicians and insurers while—at least in the case of buprenorphine—impeding the delivery of high-quality care and almost certainly harming patients.

Darius A. Rastegar, MD

Reference: Landis RK, Opper I, Saloner B, et al. Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: the effects of Medicaid prior authorization policies. Drug Alcohol Depend. 2022;241:109669.