Impact of the X-Waiver Elimination on Buprenorphine Prescribing by Non-Physician Clinicians: An Interrupted Time Series Analysis
Author(s)
Filmon T. Wolde1, Bradley Martin, RPh, PharmD, PhD2, Laura E. Gressler, MS, PhD2, Chenghui Li, PhD2, Mahip Acharya, PhD2, Corey J. Hayes, MPH, PharmD, PhD2;
1University of Arkansas for Medical Sciences (UAMS), Graduate Research Assistant, Little Rock, AR, USA, 2University of Arkansas for Medical Sciences, Little rock, AR, USA
1University of Arkansas for Medical Sciences (UAMS), Graduate Research Assistant, Little Rock, AR, USA, 2University of Arkansas for Medical Sciences, Little rock, AR, USA
Presentation Documents
OBJECTIVES: On January 12, 2023, the federal X-waiver requirement was eliminated to broaden buprenorphine access. However, preexisting laws in some states continued to restrict prescribers that could prescribe buprenorphine undermining federal efforts to expand access. This study sought to assess the influence of removing the X-waiver between states with and without buprenorphine prescriber restrictions on the number of unique non-physician prescribers (i.e., Physician Assistants [PAs] and Advanced Practice Nurses [APNs]) among commercially insured individuals in the United States.
METHODS: We conducted an interrupted time series analysis using IQVIA Pharmetrics Plus claims data on active Physician Assistants (PAs) and Advanced Practice Nurses (APNs) from January 2021 through December 2023. The pre-intervention period was from January 2021 through November 2022, and the post-intervention period was from January 2023 to December 2023. The number of prescribers per 10,000 active prescribers, were examined separately for states with (n=14) and without restrictions (n=36). Models were stratified by provider type (PAs and APNs) and in combination as Advanced Practice Providers (APPs).
RESULTS: For PAs, the elimination of the X-waiver led to significant immediate increases in rates of prescribers in both restricted (+13.48, p = 0.0164) and non-restricted states (+6.00, p = 0.0001). However, in non-restricted states, prescribing rates significantly declined over the post-intervention period (-0.36, p = 0.0407), while no significant post intervention trend emerged in restricted states. No differences in intercept shift or trend were observed for APNs. Combined APP rates in restricted states rose significantly (+8.70, p = 0.0237), although no significant post-intervention trend was observed (-0.10, p = 0.827).
CONCLUSIONS: Eliminating the X-waiver had a more immediate and pronounced impact on PA prescribers, but the impact was less sustained in states that continued restrictions. APNs were already experiencing steady increases in buprenorphine prescribing before the intervention, suggesting that the waiver removal did not increase prescribing amongst APNs.
METHODS: We conducted an interrupted time series analysis using IQVIA Pharmetrics Plus claims data on active Physician Assistants (PAs) and Advanced Practice Nurses (APNs) from January 2021 through December 2023. The pre-intervention period was from January 2021 through November 2022, and the post-intervention period was from January 2023 to December 2023. The number of prescribers per 10,000 active prescribers, were examined separately for states with (n=14) and without restrictions (n=36). Models were stratified by provider type (PAs and APNs) and in combination as Advanced Practice Providers (APPs).
RESULTS: For PAs, the elimination of the X-waiver led to significant immediate increases in rates of prescribers in both restricted (+13.48, p = 0.0164) and non-restricted states (+6.00, p = 0.0001). However, in non-restricted states, prescribing rates significantly declined over the post-intervention period (-0.36, p = 0.0407), while no significant post intervention trend emerged in restricted states. No differences in intercept shift or trend were observed for APNs. Combined APP rates in restricted states rose significantly (+8.70, p = 0.0237), although no significant post-intervention trend was observed (-0.10, p = 0.827).
CONCLUSIONS: Eliminating the X-waiver had a more immediate and pronounced impact on PA prescribers, but the impact was less sustained in states that continued restrictions. APNs were already experiencing steady increases in buprenorphine prescribing before the intervention, suggesting that the waiver removal did not increase prescribing amongst APNs.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR78
Topic
Health Policy & Regulatory
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Mental Health (including addition)