Buprenorphine Out-of-Pocket Expenses Decreasing in the US

Compared with 2015 rates, out-of-pocket expenses for buprenorphine were lower in 2020, according to a study published in JAMA Network Open.

The investigators from the Centers for Disease Control and Prevention sourced data for this study from the IQVIA Longitudinal Prescription databases which includes data from 92% of retail pharmacy prescriptions in the United States. This study evaluated the out-of-pocket costs of buprenorphine prescriptions dispensed to adults between 2015 to 2020. Costs were calculated on the basis of payer type.

Overall, 7,375,508-13,486,822 buprenorphine prescriptions were dispensed yearly between 2015 and 2020. Each year the median daily out-of-pocket costs decreased from $0.73 (IQR, $0.00-$8.49) in 2005 to $0.12 (IQR, $0.00-$1.48) in 2020.

Stratified by payer type, in 2005, 1,990,569 prescriptions were dispensed to individuals with private or commercial insurance, 1,736,811 to individuals covered by Medicaid, 1,693,406 to individuals receiving assistance, 850,021 self-payers, 668,583 individuals with unknown coverage, and 436,118 individuals with Medicare. The median daily out-of-pocket expenses were highest for self-pay (median, $8.98), followed by those receiving assistance (median, $8.67), individuals with private or commercial insurance (median, $1.56), those with unknown coverage (median, $1.21), individuals receiving Medicare (median, $0.13), and Medicaid (median, $0.04).

In 2020, a greater proportion of the buprenorphine prescriptions were dispensed to individuals with Medicaid (43.00% vs 23.55%) and Medicare (10.16% vs 5.91%) coverage compared with 2015, respectively. Stratified by payer type, the median daily cost of buprenorphine ranged between a median of $7.50 for self-payers to $0.00 for those covered by Medicaid.

In 2020, 74.37% of prescriptions were generic and the average day supply dispensed was 17.59 days. More self-payers received generic prescriptions (94.81%) and the longest and shortest supplies were observed among individuals with unknown coverage (mean, 22.63 days) and self-pay (mean, 12.62 days), respectively.

Stratified by demographic characteristics, daily costs in 2020 were higher in the South (mean, $2.91) compared with the Northeast, Midwest, or West (mean range, $1.04-$1.32) and for those of unknown gender (mean, $3.01) or men (mean, $2.11) compared with women (mean, $2.11) whereas costs were lowest for individuals aged over 65 years (mean, $1.32) compared with younger adults (mean range, $1.46-$2.10) and there was little difference between costs in metropolitan (mean, $1.93) and nonmetropolitan (mean, $1.80) areas.

Stratified by payer type and demographics, the highest average out-of-pocket costs in 2020 were observed among self-pay individuals aged 45 to 54 years (mean, $8.81), living in the South (mean, $8.73), aged 35 to 24 years (mean, $8.63), and women (mean, $8.51).

These findings should be interpreted with caution, as it remains unclear what proportion of patients received buprenorphine for medications for opioid use disorder or for off-label pain analgesics.

Study authors concluded, “Findings showed that while mean daily out-of-pocket costs for buprenorphine decreased between 2015 and 2020, costs continued to vary by payer and remain high for some in 2020. Public health and insurer strategies aimed at reducing higher patient out-of-pocket costs may address financial barriers and improve buprenorphine treatment retention.”

This article originally appeared on Clinical Pain Advisor