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Abstract

Purpose: To evaluate changes in buprenorphine dispensing for treatment of opioid use disorder (OUD) among Kentucky Medicaid enrollees following the removal of prior authorization (PA) requirements for the transmucosal buprenorphine combination product.

Methods: We analyzed Kentucky Medicaid claims from 1/1/2016 through 6/30/2023 to identify enrollees with OUD during each quarter (Q1/2017–Q2/2023), using a 12-month lookback window. Segmented regression analysis was used for statistical modeling of an interrupted time series (ITS) design to assess changes in the quarterly proportion of enrollees with OUD receiving buprenorphine for OUD treatment, focusing on the effect of PA removal. The effective date of the PA removal was February 22, 2019 and thus Q1/2019 was treated as a roll-in period for policy implementation.

Results: The quarterly proportion of enrollees with OUD receiving buprenorphine ranged from 0.29 to 0.44 across the study period. Prior to removal of PA requirements for transmucosal buprenorphine, this proportion was increasing at a modest rate (ITS pre-policy slope +0.009; 95% CI 0.008–0.011). The immediate estimated effect of the full PA removal implementation (Q4/2018 to Q2/2019) was a 4-percentage-point increase (level change +0.04; 95% CI 0.03–0.05) followed by a deceleration in growth (slope change −0.006; 95% CI −0.008– −0.005).

Conclusions: Removal of transmucosal buprenorphine PA requirements for Kentucky Medicaid enrollees was associated with a significant immediate increase in buprenorphine dispensing for OUD treatment. Future research should evaluate how post-PA removal trends interact with the Kentucky Medicaid’s coverage of methadone for OUD beginning in Q3/2019.

Document Type

Article

Publication Date

2026

Notes/Citation Information

0376-8716/© 2026 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Digital Object Identifier (DOI)

https://doi.org/10.1016/j.drugalcdep.2026.113105

Funding Information

This research was funded by the National Institutes of Health (NIH) through the NIH HEAL (Helping to End Addiction Long-term®) Initiative under award number UM1DA049406, the NIH National Institute On Drug Abuse (NIDA) under Award Number R01DA057605, Rapid Actionable Data for Opioid Response in Kentucky (RADOR-KY), and the NIH National Center for Advancing Translational Sciences (NCATS) through grant number TL1TR001997. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, NIH HEAL Initiative®, NIDA, or NCATS. The funding sources had no role in the study design, collection, analysis or interpretation of data, or the decision to submit the article for publication.

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