A state law banning insurance pre-authorization for buprenorphine, a leading treatment for opioid use disorder, may not help more patients stay on treatment for the recommended minimum 180 days, Weill Cornell Medicine researchers report. Prescribed buprenorphine can be a lifesaving treatment that reduces opioid craving and withdrawal symptoms, but compliance rates are low.
Posted on March 6th JAMA Health Forumthis study investigated whether state laws prohibiting private insurance plans from requiring prior authorization improve treatment retention, which is critical to reducing relapse, overdose risk, and death. From 2023 to 2024, overdose deaths experienced the largest annual decline since 2019, but nearly 55,000 people still died from opioid overdose in 2024.
As more states enact preauthorization bans to facilitate access to life-saving medications for opioid use disorder, our findings suggest that effective strategies must address multiple interacting barriers, including drug testing, counseling, and drug quantity limit requirements. ”
Dr. Yuhua Bao, Senior Author, Professor of Population Health Sciences, Weill Cornell University
Prior authorization is an administrative process that insurance companies employ to control the use of therapeutic drugs. Insurance company approval is required for coverage before patients receive treatment. In the case of buprenorphine, if an individual has to wait to start treatment, refill a prescription, or switch to another medication, that process can delay or interrupt treatment. Approval is usually granted for a limited time, which can cause delays after treatment begins.
The study included approximately 23,000 patients aged 18 to 64 who newly started buprenorphine treatment from January 2015 to June 2022. During this time, new laws were enacted in 19 states that prohibit private insurance from requiring prior authorization for buprenorphine.
They found that less than a third (30.4%) of patients included in the study continued treatment for at least 180 days with no more than 7 days between treatments. Even when the interval between prescriptions increased, 180-day retention remained low. Less than half of the sample (45.7%) continued treatment without an interval of more than 30 days.
Patients in states with prior authorization bans did not have statistically significant changes in retention rates compared with patients in states without prior authorization bans.
“Our study provides timely and policy-relevant evidence to help address persistent gaps in the treatment of opioid use disorder,” said study lead author Alison Juchen Hu, assistant professor at Tulane University School of Public Health and Tropical Medicine. “Without implementation of complementary interventions, as well as thorough enforcement and monitoring of private insurer compliance, legal bans on prior authorization may have limited effectiveness in closing treatment gaps.” Dr. Hu collaborated with Dr. Bao during the study as a postdoctoral fellow at Weill Cornell University.
Broader policy measures could also help individuals achieve better outcomes, including ensuring more available provider support, reducing treatment stigma, and facilitating easier access to counseling and recovery services.
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Reference magazines:
Hu, J.C.; others. (2026). Specifies prohibition of prior authorization and retention of buprenorphine in patients with private insurance. JAMA Health Forum. 10.1001/jamahealthforum.2026.0012. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2845633
