State laws that ban insurance prior authorization for buprenorphine, a medication used to treat opioid use disorder, may not lead to more patients staying in treatment for the recommended minimum of 180 days, according to research from Weill Cornell Medicine. The study was published on March 6 in JAMA Health Forum.
Buprenorphine is known for relieving opioid cravings and withdrawal symptoms, but adherence rates remain low. The administrative process called prior authorization requires insurer approval before patients can access treatment. This process can delay or interrupt therapy when individuals wait to start treatments, refill prescriptions, or switch medications. Even after starting treatment, delays may occur since approvals are typically granted only for limited periods.
The researchers analyzed data from about 23,000 patients aged 18 to 64 who began new buprenorphine treatments between January 2015 and June 2022. During this period, 19 states enacted laws prohibiting private insurers from requiring prior authorization for buprenorphine.
Results showed that fewer than one-third (30.4%) of patients remained in treatment for at least 180 days without gaps longer than seven days. When allowing for gaps up to 30 days between prescriptions, less than half (45.7%) stayed on treatment during the same period.
There was no statistically significant difference in retention rates between patients in states with prior authorization bans and those in states without such bans.
"Our study provides timely and policy-relevant evidence to help address persistent gaps in opioid use disorder treatment," said Dr. Allison Ju-Chen Hu, assistant professor at Tulane University School of Public Health and Tropical Medicine and first author of the study. "Without robust enforcement and monitoring of private insurers' compliance-in addition to the implementation of complementary interventions-legislative bans on prior authorization may have limited impact on closing treatment gaps." Dr. Hu was a postdoctoral associate at Weill Cornell working with Dr. Bao during the study.
The authors suggest that broader policy measures could support better outcomes by increasing provider availability, reducing stigma around treatment, and improving access to counseling and recovery services.
