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Buprenorphine-naloxone underutilized by Medicare prescribers

Prescription of buprenorphine-naloxone was significantly lower than prescription of opioid painkillers among Medicare prescribers, according to recent findings.

“The population that uses Medicare has among the highest and most rapidly growing prevalence of opioid use disorder, with more than six of every 1,000 patients (more than 300,000 of 55 million) diagnosed and with hospitalizations increasing 10% per year. Data on patients with commercial insurance plans show just more than one of every 1,000 patients diagnosed,” Anna Lembke, MD, and Jonathan H. Chen, MD, PhD, of Stanford University School of Medicine, California, wrote. “Prevention initiatives are essential for reducing the number of new patients with opioid use disorder, but treatment will be required for those already addicted to opioids.”

To compare prescription of buprenorphine-naloxone with prescription of Schedule II opioid painkillers, researchers analyzed data from individual prescribers from the 2013 Medicare Part D claims data set, which covers approximately 68% of the estimated 55 million individuals receiving Medicare. Data represented 1,188,393,892 claims that cost $80,941,763,731.

There were 6,707 prescribers with 486,099 claims for buprenorphine-naloxone, written for approximately 81,000 patients, compared with 381,575 prescribers with 56,516,854 claims for Schedule II opioids.

For every 40 family practice physicians who prescribed opioid painkillers, there was one family practice physician who prescribed buprenorphine-naloxone (71,718 vs. 1,793).

“Pain physicians averaged on the order of thousands of opioid painkiller prescriptions per prescriber compared with a negligible number of buprenorphine-naloxone prescriptions (mostly < 5),” according to researchers.

Buprenorphine-naloxone was prescribed most frequently by physicians whose primary specialty was addiction, with 98.8 claims per year. However, there were only 100 such Medicare prescribers in the United States.

The top six states by buprenorphine-naloxone claims ratio, defined by researchers as the number of claims in a drug subset divided by total number of claims for all drugs, included Vermont, Maine, Massachusetts, Rhode Island, Washington, D.C., and New Hampshire. These states had claims ratios more than 300 times higher than the national average.

“Buprenorphine-naloxone is underused by Medicare prescribers. Geographic differences in buprenorphine-naloxone prescribing should be explored to assess state-level variations in advocacy for and barriers to its use,” the researchers wrote. “To combat the current prescription opioid epidemic, integration and promotion of [opioid agonist therapy] should be encouraged, and not just among addiction medicine specialists, who are far too few to meet the current and projected need. Physicians who prescribe high volumes of opioids and thus already have an established therapeutic alliance and prior experience with opioid prescribing are especially well-situated, with some additional training, to intervene when cases of prescription opioid misuse, overuse, and use disorders arise.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.