ArticleHealth services research2014
The impact of prior authorization on buprenorphine dose, relapse rates, and cost for Massachusetts Medicaid beneficiaries with opioid dependence.
Article in Health services research, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.
- Evidence for state, community and systems-level prevention strategies to address the opioid crisis.Drug and alcohol dependence · 2019Pooled it
- Cross-sectional examination of characteristics of higher-dose buprenorphine prescriptions during the era of illicit fentanyl.Addiction science & clinical practice · 2025Article
- Medicaid managed care restrictions on medications for the treatment of opioid use disorder.Health services research · 2025Article
- State Medicaid Policies Governing Access to Medications for Opioid Use Disorder (MOUD) and MOUD Treatment Use in a Large Sample of People Who Inject Drugs in 20 U.S. States.Substance use & misuse · 2025Article
- Payment-related barriers to medications for opioid use disorder: A critical review of the literature and real-world application.Journal of substance use and addiction treatment · 2024Review
- Thematic Analysis of State Medicaid Buprenorphine Prior Authorization Requirements.JAMA network open · 2023Review
- Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policies.Drug and alcohol dependence · 2022Article
- Buprenorphine Use Trends Following Removal of Prior Authorization Policies for the Treatment of Opioid Use Disorder in 2 State Medicaid Programs.JAMA health forum · 2022Article
- Opioid use disorder: a neglected human immunodeficiency virus risk in American adolescents.AIDS (London, England) · 2021Article
- Cost containment by peer prior authorization program for second line treatment in patients with retinal disease.Israel journal of health policy research · 2021Article
- A comparison of trends in opioid dispensing patterns between Medicaid pharmacy claims and prescription drug monitoring program data.Pharmacoepidemiology and drug safety · 2020Article
- Impact Of Long-Term Buprenorphine Treatment On Adverse Health Care Outcomes In Medicaid.Health affairs (Project Hope) · 2020Article
- The Association of State Opioid Misuse Prevention Policies With Patient- and Provider-Related Outcomes: A Scoping Review.The Milbank quarterly · 2020Article
- Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder.JAMA network open · 2020Article
- Impact of a jail-based treatment decision-making intervention on post-release initiation of medications for opioid use disorder.Drug and alcohol dependence · 2020Observational
- US physicians' decision-making during buprenorphine-naloxone treatment: Conjoint analyses of dose and office visit adjustments based on patient progress.Drug and alcohol dependence · 2019Article
- Probation clients' barriers to access and use of opioid use disorder medications.Health & justice · 2019Article
- Physicians as Mediators of Health Policy: Acceptance of Medicaid in the Context of Buprenorphine Treatment.The journal of behavioral health services & research · 2019Article
- Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment.American journal of preventive medicine · 2018Article
- The Effect of Formulary Restrictions on Patient and Payer Outcomes: A Systematic Literature Review.Journal of managed care & specialty pharmacy · 2017Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo assess the impact of a 2008 dose-based prior authorization policy for Massachusetts Medicaid beneficiaries using buprenorphine + naloxone for opioid addiction treatment. Doses higher than 16 mg required progressively more frequent authorizations. DATA SOURCES: Mediciaid claims for 2007 and 2008 linked with Department of Public Health (DPH) service records. STUDY
designWe conducted time series for all buprenorphine users and a longitudinal cohort analysis of 2,049 individuals who began buprenorphine treatment in 2007. Outcome measures included use of relapse-related services, health care expenditures per person, and buprenorphine expenditures. DATA COLLECTION/EXTRACTION
methodsWe used ICD-9 codes and National Drug Codes to identify individuals with opioid dependence who filled prescriptions for buprenorphine. Medicaid and DPH data were linked with individual identifiers. PRINCIPAL
findingsIndividuals using doses >24 mg decreased from 16.5 to 4.1 percent. Relapses increased temporarily for some users but returned to previous levels within 3 months. Buprenorphine expenditures decreased but total expenditures did not change significantly.
conclusionPrior authorization policies strategically targeted by dose level appear to successfully reduce use of higher than recommended buprenorphine doses. Savings from these policies are modest and may be accompanied by brief increases in relapse rates. Lower doses may decrease diversion of buprenorphine.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.