IMPACT OF COVID-19-RELATED REGULATORY CHANGES ON NATIONWIDE ACCESS TO BUPRENORPHINE AND TREATMENT DISRUPTIONS

ABSTRACT

BACKGROUND: The intersection of the opioid overdose epidemic and COVID-19 pandemic has prompted major regulatory changes to ease access to medications for opioid use disorder via telemedicine. We examined the impact of COVID-19-related health care changes on access to buprenorphine (BUP) by age, gender, insurance category, and prescriber specialty using a nationwide longitudinal prescription database. METHODS: We used an interrupted time series design with IQVIA LRx, a longitudinal database with >90% of all prescriptions dispensed in the US. The study timeline included BUP prescriptions from 52 weeks before (2/23/19- 2/21/20) to 52 weeks after (3/28/20-4/2/21) the initial pandemic period (2/22/ 20-3/27/20). The outcome of interest was total milligrams (MG) of BUP available per week nationwide. We used the CMS NPI database to assign prescriber specialty. Segmented regression was used to estimate relative changes in BUP prescribing at 1, 26, and 52 weeks post- initial-pandemic period compared to the expected baseline trend. We also evaluated treatment disruptions (a gap of 28 days) in previously stable patients, defined as ≥6 months of BUP prescriptions without a treatment disruption. RESULTS: A total of 31,801,061 prescriptions were included. The number of patients with an active BUP prescription was increasing in the 52 weeks prepandemic (trend 1252 pat./wk.) and increased significantly in the 1st week post- initial-pandemic period (level change 25786, p<0.001). The total MG BUP dispensed increased at 1, 26, and 52 weeks compared to the expected baseline trend (5.3% [4.9, 5.7], 3.3% [2.8, 3.8], 1.2% [0.48, 1.9]), as did the mean days supplied (9.3% [8.7, 9.9], 4.9% [4.3, 5.5], 6.3% [5.4, 7.3]). Stablytreated patients saw a significant decrease in treatment disruptions at 52 weeks post-initial-pandemic period (-28.4% [-33.7, -23.0]) compared to the expected baseline trend. Older age groups (40+) experienced an increase inMG BUP at 52 weeks (40-49 4.9 [3.9, 5.9];50-64 3.0 [0.75, 5.2];65+ 4.5 [3.4, 5.6]), while people aged 18-29 saw a significant decrease in MG BUP (-16.5 [-24.1, -8.8]). Men retained a significant increase in MG BUP compared to women at 52 weeks (1.7% [1.0, 2.4] v 0.5% [-0.34, 1.3]). People with Medicaid had a significant increase in MG BUP at 52 weeks (9.6% [7.7, 11.6]) while people paying with cash (-10.1 [-12.3, -7.9]) and commercial insurance (-4.6 [-5.7, -3.4]) saw significant decreases compared to the expected baseline trend. APPs, compared to physician specialties, had a notable increase in MG BUP dispensed at 1, 26, and 52 weeks (10.0 [8.8, 11.2], 7.1 [5.9, 8.4], 2.8 [0.13, 5.4]). CONCLUSIONS: In the year after the initial COVID-19 pandemic period, patients received longer prescriptions of BUP and overall increased total MG BUP. Stably-treated patients experienced fewer treatment disruptions. Regulatory changes around BUP prescribing may have helped patients maintain access to MOUD during the pandemic.