Systems and Policies
Several structural determinants shape buprenorphine availability, from government auditing of pharmacies to limited payer coverage.
Barriers
Pharmacies face federal and state regulatory barriers to buprenorphine dispensing. The DEA requires pharmacies to report large or unusual orders of opioids. Under this landscape, pharmacies may limit order quantities and frequencies, which in turn drives down the available supply of buprenorphine for dispensing. This leads to delayed or suspended shipments, the entire elimination of buprenorphine stocks at some pharmacies, and prescriptions being declined or not filled.
Payer type can also pose a significant structural barrier to buprenorphine for chronic pain access. One study demonstrates that oxycodone and morphine were covered at significantly higher rates than buprenorphine.
Facilitators
The Department of Health and Human Services’ Pain Management Best Practices Inter-Agency Task Force has called for updated payer policies to align with current evidence on best practices for increasing buprenorphine access in appropriate settings. This marks a public acknowledgment of policy misalignment between evidence and practice. Continued calls such as these may encourage state and private payers to update coverage policies to support more accessible buprenorphine among those who stand to benefit from a safer long-term opioid therapy.