Factors Affecting Buprenorphine Utilization and Spending in Medicaid, 2002-2018

Feb 1, 2021, 00:00
10.1016/j.jval.2020.04.1840
https://www.valueinhealthjournal.com/article/S1098-3015(20)34398-9/fulltext
Title : Factors Affecting Buprenorphine Utilization and Spending in Medicaid, 2002-2018
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(20)34398-9&doi=10.1016/j.jval.2020.04.1840
First page : 182
Section Title : THEMED SECTION: OPIOID MISUSE: A GLOBAL CRISIS
Open access? : No
Section Order : 182

Objective

Buprenorphine is an essential medication for the treatment of opioid use disorder (OUD), but studies show it has been underused over the last 2 decades. We sought to evaluate utilization of and spending on buprenorphine formulations in Medicaid and to evaluate the impact of key market and regulatory factors affecting availability of different formulations and generic versions.

Methods

We first identified all buprenorphine formulations approved by the Food and Drug Administration for OUD using Drugs@FDA. We then used National Drug Codes to identify each drug in the Medicaid State Drug Utilization Data and extracted annual utilization rates and spending between 2002 and 2018 by drug and according to whether a brand-name or generic version was dispensed. We compared these trends to market and regulatory factors that affected competition, which we identified through searching the Federal Register, Westlaw, PubMed, and Google News.

Results

Brand-name buprenorphine-naloxone sublingual tablet and film formulations (Suboxone) were dispensed 2.7 times more (n = 634 213 140) and reimbursed 4.4 times more (n = $4 440 556 473) than all other formulations combined (n = 237 769 689; $1 018 988 133). We identified numerous market and regulatory factors that contributed to an estimated 9-year delay in generic versions of the tablet formulation and 6-year delay for generic versions of the film formulation.

Conclusions

Brand-name buprenorphine formulations have been widely used in Medicaid, leading to substantial costs, in part because generic versions were delayed by multiple years owing to market and regulatory factors. Timely availability of low-cost generics could have helped encourage OUD treatment with buprenorphine during the height of the opioid crisis.

Categories :
  • Generics
  • Health Policy & Regulatory
  • Health Service Delivery & Process of Care
  • Insurance Systems & National Health Care
  • Prescribing Behavior
  • Prevalence, Incidence & Disease Risk Factors
  • Public Spending & National Health Expenditures
  • Reimbursement & Access Policy
Tags :
  • access
  • affordability
  • buprenorphine
  • opioid use disorder
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