The United States (US) has implemented several government policy reforms to expand the prescription of buprenorphine as a persistent treatment for opioid use disorder (OUD) since 2018. Researchers analyzed all-payer and per-payer prescriptions across states from 2018 to 2024 using IQVIA data. Buprenorphine policies were changed during the opioid public health emergency in the U.S, which correlated with a 57% rise in overdose deaths.
The most popular type of medicine for OUD is buprenorphine, which can be prescribed through telemedicine and office-based modalities without the need for regular attendance and close monitoring. Federal reforms included the Consolidated Appropriations Act of 2019, which allowed clinicians to prescribe buprenorphine for up to 30 patients without a federal X waiver. They expanded telehealth prescribing during the coronavirus disease 2019 (COVID-19) pandemic.
Despite expectations of rapid uptake, the overall national increase was modest, reflecting significant state-level variation. Medicaid is the largest payer for buprenorphine, which played a central role, but eligibility restrictions, utilization management, and payment structures limited the impact of federal policies. National Drug Codes were used to identify prescriptions for buprenorphine except for versions prescribed for pain relief.
The percentage of medicines paid for fully by self-pay and the percentage reimbursed by Medicaid were also compared. The variables were difficult to measure changes in policies and private insurance coverage at the state level. The study offers several benefits, including the capacity to break down national patterns and changes across all payers through 2024, including prescriptions filled by registered pharmacies.
In 2022, the rate of all-payer prescriptions increased from 41.0 per 1000 people as compared to 45.1 in 2018. At the same time, 10 states recorded increases of more than 60%, while 8 states reported declines greater than 10%. From 4.2 per 1000 in 2018, the number of self-pay prescriptions decreased in 2022 to 2.6, and further to 2.5 per 1000 in 2024. In 2022, Medicaid’s prescription rates rose from 36.2% to 46.5%. Some states had 38-fold different all-payer prescription rates in 2024 that ranged from 9.3 to 355.5 per 1000. Medicaid expansions in Arkansas, Virginia, and several Midwestern and Western states led to prescription increases exceeding 25%. In contrast, non-expansion states saw limited growth, with prescriptions rising from 2.5 to 4.9 per 1,000 between 2018 and 2024.
The rates at which buprenorphine was prescribed under Medicaid in 2024 varied by more than 400 times, from 0.5 in Texas to 217.2 per 1000 in the West Virginia region. Between Texas and Kentucky, Medicaid covered 3.6% of all medications in 2024. Prescriptions covered by Medicaid were 2.5 in 2018 and 4.9 per 1000 in 2024, which represents a 2.1% decrease in all-payer in non-expansion states.
Researchers observed that the correlation between the self-pay proportion and the Medicaid proportion ranges from 0.7% to 30.8%. Different changes at the state level indicate that state-specific factors moderated the effects of federal policy. Medicaid plays a crucial role in the overall prescription rate, underscoring the significance of public health in expanding access for single adults.
References: Crystal S, Xie F, Samples H, et al. States with substantial increases in buprenorphine uptake did so with increased Medicaid prescribing, 2018–24. Health Aff. 2025;44(9):1102-1111. doi:10.1377/hlthaff.2025.00343
