Prior authorization bans for buprenorphine alone may not improve treatment retention

(Press-News.org) State laws that ban insurance prior authorization for buprenorphine—a leading medication for opioid use disorder—may not help more patients stay in treatment for the recommended minimum of 180 days, Weill Cornell Medicine researchers report. Though prescription buprenorphine can be a life-saving treatment that relieves opioid cravings and withdrawal symptoms, adherence to the medication is low.

Published Mar. 6 in JAMA Health Forum, the study examined whether state laws prohibiting private insurance plans from requiring prior authorization improved treatment retention, which is essential for reducing relapse, overdose risk and death. While the 2023–2024 period saw the largest annual decrease in overdose deaths since 2019, nearly 55,000 people still died from opioid overdose in 2024.

“As more states enact prior authorization prohibitions to facilitate access to life-saving medications for opioid use disorder, our findings suggest that effective strategies will have to address multiple and interacting barriers such as requiring drug testing, counseling or quantity limits for medication,” said senior author Dr. Yuhua Bao, professor of population health sciences at Weill Cornell.

Prior authorization is an administrative process that insurers employ to control the use of therapeutics. It requires insurer approval for coverage before a patient receives treatment. For buprenorphine, the process can delay or interrupt therapy when individuals must wait to initiate treatments, refill prescriptions, or switch to different medicines. Delays still may occur after starting treatment, since approvals are typically granted for a limited duration.

The study included approximately 23,000 patients aged 18 to 64 who started new buprenorphine treatments between January 2015 and June 2022. During this time, 19 states implemented new laws prohibiting private insurance from requiring prior authorization for buprenorphine.

They found that, among the patients included in the study, fewer than one-third (30.4%) stayed in treatment for at least 180 days without gaps exceeding seven days. The 180-day retention rate remained low even when allowing for longer gaps between prescriptions—less than half of the sample (45.7%) stayed on treatment without gaps longer than 30 days.

Patients in states with prior authorization prohibitions did not see a statistically significant change in retention compared to patients in states without prior authorization prohibitions.

“Our study provides timely and policy-relevant evidence to help address persistent gaps in opioid use disorder treatment,” said the study’s first author, Dr. Allison Ju-Chen Hu, assistant professor at Tulane University School of Public Health and Tropical Medicine. “Without robust enforcement and monitoring of private insurers’ compliance—in addition to the implementation of complementary interventions—legislative bans on prior authorization may have limited impact on closing treatment gaps.” Dr. Hu was a postdoctoral associate at Weill Cornell working with Dr. Bao during the study.

Broader policy actions may also help individuals achieve better outcomes, including ensuring support through more available providers, less stigma around treatment and easier access to counseling and recovery services.

 

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