P.c change in all-payer buprenorphine prescription fills per 1,000 inhabitants within the US between 2018 and 2024, by state. Credit score: Well being Affairs (2025). DOI: 10.1377/hlthaff.2025.00343
Medicaid performs a key function for giving individuals with opioid-use dysfunction entry to therapy, based on a Rutgers Well being examine. Progress in life-saving therapy for opioid-use dysfunction with the treatment has stalled prior to now a number of years. Whereas some states have been capable of obtain substantial enchancment, others misplaced floor.
Particularly, states which have expanded entry to Medicaid insurance coverage protection since 2018 noticed will increase in prescriptions for opioid-use dysfunction therapy, based on the examine, whereas states that have not expanded Medicaid skilled declining therapy charges after 2022.
Researchers discovered that state Medicaid insurance policies have been key drivers of population-level therapy charges.
The examine, printed in Well being Affairs, examined developments in nationwide retail pharmacy claims by Medicaid, Medicare and personal insurance coverage throughout states between 2018 and 2024, a interval of rising deadly overdose charges and nationwide coverage adjustments geared toward rising therapy. Researchers in contrast the claims with state populations and overdose charges to evaluate the impression of Medicaid eligibility on therapy uptake.
“We were impressed by the success stories in some states, such as those with recent eligibility expansions,” mentioned Stephen Crystal, director of the Rutgers Middle for Well being Companies Analysis on the Institute for Well being, Well being Care Coverage and Getting old Analysis.
“Several of these states, like Virginia, Utah and Missouri, doubled or tripled Medicaid-paid prescribing, driving strong population-level improvement. These successes point to opportunities for improvement even when the overall national rate of progress is disappointing. Nevertheless, wide disparities between states remained, as shown in maps and state comparison tables in the paper and its appendix.”
Regardless of the provision of efficient therapies for opioid-use dysfunction, greater than 80,000 died in 2024from opioid-use overdoses. Along with the illness of habit, there are a variety of coverage and monetary limitations stopping individuals from accessing treatment, the researchers mentioned. The federal authorities declared an opioid public well being emergency in 2017 and once more in 2025.
As a result of individuals with opioid-use dysfunction are usually low-income single adults, Medicaid is an important payer for buprenorphine, a extremely efficient treatment used to deal with opioid-use dysfunction. Nevertheless, Medicaid insurance policies masking opioid-use dysfunction therapy range state to state, leading to vastly totally different uptake of therapies that may dramatically decrease the danger of overdose and help restoration.
New Jersey is among the many states which have carried out vital initiatives which have aided entry to Medicaid-paid therapy, together with Medicaid enlargement, elimination of buprenorphine prior authorization, and elevated reimbursement for therapy, with enhancements in Medicaid and all-payer buprenorphine prescribing through the examine interval.
The nationwide evaluation led by Crystal, who’s a Distinguished Analysis Professor on the Rutgers Faculty of Social Work, confirmed numerous state-level developments that always pointed to the significance of Medicaid.
States that lately expanded the eligibility standards to qualify for Medicaid insurance coverage skilled a 27.3% improve in buprenorphine prescribing charges. However in states that did not broaden Medicaid, general prescribing lagged, with declines after 2022.
Researchers mentioned increasing Medicaid eligibility and minimizing disenrollment from Medicaid throughout eligibility redeterminations are important steps in rising entry to opioid-use dysfunction therapy throughout the nation.
“Translating evidence into consistent practice has been uneven across the country for multiple reasons, including the stigma surrounding people with addiction,” mentioned Crystal.
“But progress is possible when states take action to help residents access and afford effective medication. Maintaining the progress that has been made in opioid-use disorder treatment through state Medicaid policies will be challenging under the financial pressures created by recent federal legislation, but it is vital in maintaining progress on preventing overdoses and supporting recovery.”
Co-authors of the examine embrace Fangzhou Xie, Hillary Samples, Elizabeth Stone and Jennifer Miles of Rutgers; Allen Campbell of the IQVIA Institute, Peter Treitler of Boston College; and Sumedha Gupta and Kosali I. Simon of Indiana College.
Extra info:
Stephen Crystal et al, States With Substantial Will increase In Buprenorphine Uptake Did So With Elevated Medicaid Prescribing, 2018–24, Well being Affairs (2025). DOI: 10.1377/hlthaff.2025.00343
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