Unrestricted insurance coverage of buprenorphine formulations remains sparse in comparison to conventional opioids.

Abstract

Objective: Buprenorphine is an atypical opioid with analgesic efficacy and a more favorable safety profile than conventional opioids or tramadol. In 2019, access to on-label buprenorphine formulations was limited in comparison to conventional opioids, despite evidence supporting buprenorphine's first-line analgesic use. Considering recent policy changes increasing buprenorphine accessibility, we determined differences in unrestricted insurance coverage between buprenorphine, conventional opioids, and other atypical opioids.

Methods: We used data from Managed Market Insights and Technology's Coverage Search and Kaiser Family Foundation to generate estimates on percentages of US-covered lives with unrestricted access to oxycodone, morphine, tramadol, tapentadol, generic and on-label transdermal buprenorphine, on-label buccal buprenorphine, and on-label sublingual buprenorphine/naloxone in 2024.

Results: 79.7% of commercial and 99.1% of Medicare lives had unrestricted oxycodone access. Morphine access was unrestricted for 45.7% of commercial and 62.8% of Medicare lives. Unrestricted access to tramadol was available for 88.2% of commercial and 96.3% of Medicare lives. 37.3% of commercial and 10.1% of Medicare lives had unrestricted tapentadol access. Unrestricted access to on-label transdermal buprenorphine was available for 21.0% of commercial and 2.59% of Medicare lives. Generic transdermal buprenorphine was available for 52.1% of commercial and 30.0% of Medicare lives. Buccal buprenorphine was available without restriction for 52.7% of commercial and 19.8% of Medicare lives. Sublingual buprenorphine/naloxone had unrestricted coverage for 34.6% of commercial and 32.7% of Medicare lives.

Conclusions: Access to buprenorphine formulations was limited in comparison to other opioids. This study emphasizes a need for commercial and Medicare health insurance plans to broaden buprenorphine coverage.