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35th AM (2025) - Poster Session
Impact of Federal X Waiver Removal on Buprenorphin ...
Impact of Federal X Waiver Removal on Buprenorphine Prescription Patterns in the Medicare Part D Program
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This study investigated the impact of the federal X-waiver removal in December 2022 on buprenorphine prescribing patterns within the Medicare Part D program. Buprenorphine is a key medication for opioid use disorder (OUD) treatment, traditionally requiring an X-waiver for prescription. The waiver's elimination was intended to broaden access by allowing any DEA-registered provider with Schedule III authority to prescribe the medication.<br /><br />Using retrospective Medicare Part D prescription data from 2022 and 2023, the authors analyzed total buprenorphine claims across various provider categories—advanced practice providers (APPs, including nurse practitioners and physician assistants), primary care providers, specialists (psychiatry and addiction medicine), and other non-behavioral health specialists—across states. The data showed a national 4.2% increase in buprenorphine prescriptions post-waiver removal, from approximately 2.33 million claims in 2022 to 2.43 million in 2023.<br /><br />Key findings include a pronounced rise in prescribing by APPs, who displayed a 12.6% growth rate and accounted for 43.3% of total claims in 2023, surpassing all other provider groups. In contrast, specialist prescribing declined by 9.6%, with psychiatry down 10.7% and addiction medicine down 7.1%. The geographic analysis revealed significant variability in prescribing increases across states, indicating regional disparities likely influenced by local policies, workforce availability, and healthcare infrastructure.<br /><br />These patterns suggest that the X-waiver removal led more to a redistribution of prescribing responsibilities toward APPs rather than a uniform expansion of buprenorphine access nationwide. The study underscores the importance of ongoing monitoring of prescribing trends and treatment outcomes to ensure equitable access to OUD treatment, particularly among publicly insured populations at high risk. The findings have implications for workforce planning and highlight the federal policy's role in shaping buprenorphine availability.
Keywords
X-waiver removal
buprenorphine prescribing
Medicare Part D
opioid use disorder
advanced practice providers
prescription trends
specialist prescribing decline
geographic variability
federal policy impact
opioid treatment access
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