Utilization of long-acting injectable monthly depot buprenorphine for opioid use disorder (OUD) in Kentucky, before and after COVID-19 related buprenorphine access policy changes

Lindsey R Hammerslag; Jeffery Talbert; Svetla Slavova; Feitong Lei; Patricia R Freeman; Katherine R Marks; Laura C Fanucchi; Sharon L Walsh; Michelle R Lofwall

doi:10.1016/j.josat.2024.209391

Utilization of long-acting injectable monthly depot buprenorphine for opioid use disorder (OUD) in Kentucky, before and after COVID-19 related buprenorphine access policy changes

J Subst Use Addict Treat. 2024 May 11:209391. doi: 10.1016/j.josat.2024.209391. Online ahead of print.

Authors

Lindsey R Hammerslag¹, Jeffery Talbert², Svetla Slavova³, Feitong Lei⁴, Patricia R Freeman⁴, Katherine R Marks⁵, Laura C Fanucchi⁶, Sharon L Walsh⁷, Michelle R Lofwall⁷

Affiliations

¹ Institute for Biomedical Informatics, College of Medicine, University of Kentucky, United States of America. Electronic address: l.hammerslag@uky.edu.
² Institute for Biomedical Informatics, College of Medicine, University of Kentucky, United States of America.
³ Department of Biostatistics, College of Public Health, University of Kentucky, United States of America.
⁴ Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, United States of America.
⁵ Department of Behavioral Science, College of Medicine, University of Kentucky, United States of America.
⁶ Department of Internal Medicine, College of Medicine, University of Kentucky, United States of America; Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, United States of America.
⁷ Department of Behavioral Science, College of Medicine, University of Kentucky, United States of America; Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, United States of America.

PMID: 38740189
DOI: 10.1016/j.josat.2024.209391

Abstract

Introduction: Long-acting injectable buprenorphine (LAI-bup) formulations have advantages over transmucosal buprenorphine (TM-bup), but barriers may limit their utilization. Several policies shifted during the COVID-19 pandemic to promote buprenorphine access. The federal government expanded telemedicine treatment for opioid use disorder and Kentucky (KY) Medicaid lifted prior authorization requirements (PAs) for LAI-bup (i.e., Sublocade®). This retrospective cohort study evaluated changes in LAI-bup access, utilization, and retention before and after these policy changes in KY.

Methods: Individual-level TM-bup and LAI-bup dispensing record data from KY's prescription drug monitoring program examined LAI-bup utilization and retention, without a >30-day gap in coverage, for patients starting a new episode of LAI-bup treatment. Two key time periods were examined: pre-policy changes (Apr 1, 2019 - Dec 31, 2019) and post-policy changes (Apr 1, 2020 - Dec 31, 2020). Data on PA requests among Medicaid managed care organizations and availability of LAI-bup Risk Evaluation and Mitigation Strategy (REMS)-certified pharmacies were also obtained. A multivariable Cox proportional hazard regression model analysis compared pre- versus post-policy period treatment discontinuation.

Results: The number of patients initiating LAI-bup increased from 211 to 481 over the two periods. By the end of the post-policy period, 24.3 % of eligible patients were retained on LAI-bup, versus 12.5 % in the pre-policy change period. The adjusted hazard ratio, comparing discontinuation during the post- versus pre-policy change periods, was 0.70 (95 % confidence interval: 0.55-0.89). There were also more REMS-certified pharmacies and providers in the post-policy change period.

Conclusions: LAI-bup access, utilization, and retention increased after several policy changes.

Keywords: Injectable buprenorphine; Medicaid; Opioid use disorder; Prior authorizations; Risk Evaluation and Mitigation Strategy; Telemedicine; Treatment.