More than 40% of pharmacies don't have buprenorphine in stock, study finds

Many retail pharmacies do not have buprenorphine in stock, posing a problem for opioid use disorder (OUD) patients, a new study shows. 

The study was overseen by virtual OUD provider Bicycle Health and published in JAMA Network Open. The study looked at nearly 5,300 unique retail pharmacies across 32 states that were contacted by Bicycle Health’s team in 2022 on behalf of its patients. 

The study found that more than 4 in 10 pharmacies contacted did not report buprenorphine stock at the time of the request. Access to stock varied widely depending on the state and type of pharmacy queried. 

Medications for opioid use disorder (MOUD), like buprenorphine, are a gold standard of treatment. Bicycle Health has long argued that the stigma associated with opioid use, the cost of in-person treatment and lack of telehealth programs pre-COVID have stymied access to MOUD. U.S. deaths from opioid overdoses reached a record high in 2021.

Knowing patients encounter access challenges when trying to fill prescriptions for buprenorphine, Bicycle Health has curated a database of pharmacy locations that have the medication in stock and where patients report positive encounters with the pharmacists. The provider makes calls to pharmacies on behalf of all new patients. If stock is not available, the provider tries to find alternative locations for patients—but that can be tricky for those in rural locations. 

Over the past two and a half years, Bicycle has made 42,000 calls to pharmacies on behalf of 15,000 patients, the company told Fierce Healthcare.

Per the study, pharmacy chains were more likely to have buprenorphine stock (62%) compared to independent pharmacies (45%). There is no clear explanation for why this is the case, according to the provider’s director of research.

“It asks more questions than it answers,” Scott G. Weiner, M.D., told Fierce Healthcare. “It’s both concerning and perplexing.”

Provider inquiries were most often made to CVS and Walgreens locations, which reported stock 60% and 70% of the time, respectively. Inquiries made on behalf of patients occurred most often in Florida and California. Of states where more than 100 pharmacies were queried, Florida was least likely to have stock (37%) and Washington was the most likely (84%).

Pharmacies don’t keep every medication in stock. But that should be the case for buprenorphine, Weiner argues.

“Most people starting buprenorphine are in withdrawal,” he explained. “It becomes time sensitive for them to start the medicine.”

“Seeing this research published in JAMA is a ‘defiant hope day’ for me, because it means this issue will get the attention it deserves,” Ankit Gupta, Bicycle founder and CEO, said in a press release. “The responses we’ve gotten from some of the nation’s leading pharmacies have been inspiring, with their leaders pledging to partner with us to do better for patients long-term.”

Part of the deterrent for pharmacies to carry the medication and dispense it is the Drug Enforcement Administration (DEA) platform for suspicious order reports, SORS, Weiner said. Though it’s meant for opioids, it is being applied to buprenorphine as well. 

“We’re hearing that’s a deterrent for pharmacies to want to carry it,” he said. 

Additionally, the DEA’s proposed rules curbing telehealth flexibilities for prescribing controlled substances, which received widespread public backlash, has caused confusion among pharmacists, Weiner said. While the proposed rules have not yet been adopted, some pharmacists are operating as if they have— denying prescriptions for buprenorphine written by virtual providers like Bicycle. 

“This is a medicine that should be available on demand, especially in the middle of an epidemic,” Weiner said. “There shouldn’t be any exceptions.”