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Buprenorphine Prescribing by Nurse Practitioners, Physician Assistants, and Physicians after CARA 2016

Opioid misuse and overdoses have created a national crisis in the United States, especially among Medicaid beneficiaries. Medication-assisted treatment (MAT) with buprenorphine, together with counseling and social support, is a key strategy for treating people with opioid use disorder (OUD). However, too few healthcare providers are trained, authorized, and willing to provide MAT.

The Comprehensive Addiction and Recovery Act of 2016 (CARA, P.L. 114-198) expanded prescribing authority for buprenorphine, one of three medications approved by the U.S. Food and Drug Administration for treating OUD, to nurse practitioners and physician assistants. CARA allowed these advanced practitioners to obtain waivers under the Drug Addiction Treatment Act of 2000 (DATA 2000, P.L. 106-310), which previously limited prescribing authority to qualified physicians.

MACPAC contracted with IMPAQ International to examine changes in buprenorphine prescribing patterns among advanced practitioners in Medicaid following implementation of CARA. At the October 2019 MACPAC public meeting, staff presented a summary of findings from the IMPAQ study. This full contractor report features additional details on the analytic approach, which included analysis of retail pharmacy claims from July 2017 to June 2018 and a review of state scope of practice laws, as well as in-depth tables and maps showing patient and provider trends in buprenorphine prescribing during the study year. The results are stratified by key variables such as age group, gender, insurance type, state prescriptive authority, and provider geographic location. Researchers also performed a multivariate regression analysis to examine factors associated with receiving a buprenorphine prescription from an advanced practitioner. The report closes with a discussion of policy and research questions for further consideration.

IMPAQ found that the number of buprenorphine prescriptions increased during the study period for all payers, but particularly for the Medicaid population. For example, the number of Medicaid beneficiaries with prescriptions increased by 12 percent during the study period—a rate of increase twice that observed for all patients. In addition, the proportion of prescribers who were advanced practitioners increased substantially during the study period, suggesting that expanded prescribing authority led to an increase in prescriptions for OUD treatment.