Study: Medicaid enrollees may struggle to access buprenorphine

Female physician
Medicaid patients face barriers to accessing buprenorphine. (Getty/jacoblund)

A recent study found that buprenorphine was underused in states with high opioid-related mortality rates, especially for patients with Medicaid coverage.

And while the U.S. has made improving treatment for opioid use a priority, there are still many barriers for patients looking to get buprenorphine, according to the report published in the Annals of Internal Medicine.

In a joint effort between members of Harvard T.H. Chan School of Public Health, Harvard Medical School and the Johns Hopkins Bloomberg School of Public Health, researchers simulated patient interactions to measure access for Medicaid patients to buprenorphine. Each provider in the study was called twice, first by someone pretending to be a Medicare enrollee and then by someone pretending to have no insurance.

RELATED: Rapid opioid cutoff risky too, feds warm

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The study showed that wait times to get in to see physicians and prescribers were not long—most less than two weeks. Of the callers who pretended to be using heroin, between 36% and 48% were denied an appointment with a provider, and 50% to 66% who got appointments were not offered buprenorphine on the first visit.

Michael Barnett, assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health, says he and the other authors were surprised about how the findings fit together. 

"We found that 38% to 46% of doctors are simply not accepting patients, which is worse if you have Medicaid coverage. And many doctors require that patients come back twice to start treatment. Despite all of this, the providers that were taking patients had surprisingly short wait times, often less than a week," Barnett told FierceHealthcare.

    According to a corresponding editorial, the research identified that the biggest challenge for Medicaid enrollees looking for opioid treatment was connecting patients to physicians willing to prescribe treatment. The authors suggest a more accurate list of prescribers might improve care coordination.

    RELATED: Doctors welcome CDC’s clarification of opioid prescribing, as guideline authors say it was misapplied

    Barnett agreed the biggest challenge was "simply reaching a doctor who will answer the phone and take your insurance"; he said "it took many calls and a lot of time to actually reach a human being, which is hard even for someone healthy just trying to find a primary care doctor."

    After concluding the study, Barnett was left with several questions. First, how can patients interested in treatment get connected to physicians who can prescribe it? And how can the system encourage and educate physicians to offer access to buprenorphine as rapidly as possible?

    "Perhaps we need a national addiction hotline for providers of some sort," Barnett recommended. Barnett concluded that for patients with Medicaid, there are still many administrative hassles involved in getting buprenorphine approved that many physicians may not want to bother with.

    "The very first thing we can do to expand access there is make buprenorphine a preferred formulary drug like other standard first-line treatments for other chronic illnesses. This could save lives almost immediately," he said.

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