Pharmacy Barriers to Receiving Buprenorphine Among Patients Undergoing Telemedicine Addiction Treatment.

Importance: Buprenorphine is a first-line medication for opioid use disorder, yet many individuals face barriers to filling buprenorphine prescriptions. Telemedicine patients may have prescriptions questioned and rejected more frequently due to being perceived as a diversion risk due to their prescriber's physical distance from the pharmacy. Objective: To evaluate pharmacy challenges in filling buprenorphine prescriptions among adults receiving telemedicine treatment for opioid use disorder overall and by rural and nonrural residence. Design, Setting, and Participants: This cross-sectional study analyzed a web-based survey conducted from August to September 2024. Adult patients receiving treatment from a telemedicine practice providing low-barrier treatment for opioid use disorder in 5 US states were included. Participants were identified through electronic health records; inclusion criteria were diagnosis of opioid use disorder, enrollment in telemedicine treatment with a valid zip code, and completion of a new evaluation visit and follow-up appointment. Exposure: Rural and nonrural residence determined by patient zip codes mapped to Rural-Urban Commuting Area codes. Main Outcomes and Measures: Self-reported frequency of buprenorphine fill problems in the past year, types of fill problems, and days without buprenorphine due to pharmacy-related challenges. Results: A total of 601 patients participated, with 300 (49.9%) residing in nonrural areas, 363 (60.4%) identifying as women, and a mean (SD) age of 41.44 (8.60) years. Nearly one-third of patients (192 [31.9%]) had to go without buprenorphine due to a pharmacy-related barrier in the past 12 months, and more than one-quarter (165 [27.5%]) reported having problems filling their buprenorphine prescription. There was no statistically significant difference in the experience of buprenorphine fill problems between rural and nonrural respondents. The most common problems were that buprenorphine was unavailable and needed ordering (90 of 165 [54.5%]), insurance coverage-related barriers (37 [22.4%]), and pharmacy hesitancy in filling a telemedicine prescription (32 [19.4%]). Conclusions and Relevance: In this cross-sectional study of patients receiving telemedicine treatment for opioid use disorder, challenges filling buprenorphine prescriptions were prevalent and led to concerning periods when patients were untreated and at an increased risk of returning to nonprescribed opioid use. There is a critical need for interventions to ensure sufficient access to buprenorphine, including implementing buprenorphine stocking requirements and medication delivery services through collaborating pharmacies.