Association of Coverage-Promoting Policies With Initiation and Discontinuation of Buprenorphine Treatment During Medicaid Unwinding

Objectives: We examined associations between coverage-promoting policies and changes in initiation and discontinuation of buprenorphine treatment during Medicaid unwinding. Methods: We conducted a retrospective analysis of national retail pharmacy data (2021–2023) to examine the association between 4 separate coverage-promoting policies and the number of initiations and discontinuations of buprenorphine treatment episodes in the 6 months after unwinding began. Statistical significance was assessed using 2-sample t tests. Results: Following up with enrollees nonresponsive to renewal requests and improving ex parte renewal rates were associated with smaller decreases in initiations (−1.4 percentage point difference [pp] [95% CI: −1.5 to −1.4] and −1.5 pp [95% CI: −1.5 to −1.5], respectively) and smaller increases in discontinuations (0.6 pp [95% CI: 0.5–0.7] and 0.6 pp [95% CI: 0.6–0.7], respectively). Following up on returned mail and mostly automated renewal processing had mixed effects. Following up on returned mail was associated with a larger decrease in initiations (1.1 pp [95% CI: 1.0–1.2]) but a smaller increase in discontinuations (1.1 pp [95% CI: 1.0–1.2]); automated renewal processing was associated with a smaller decrease in initiations (−1.6 pp [95% CI: −1.6 to −1.6]) but a larger increase in discontinuations (−2.5 pp [95% CI: −2.6 to −2.5]). Conclusions: Some coverage-promoting policies were associated with smaller disruptions in buprenorphine treatment during Medicaid unwinding; potential protective effects varied by policy type.