Systems and Policies
System and policy barriers and facilitators often relate to the governmental regulations or insurance policies that allow buprenorphine to be prescribed, covered, or reimbursed.
Barriers
After successfully taking buprenorphine for the first time, patients must be linked to a reliable healthcare provider (a process called “warm handoff”) who is locally available and can continue prescribing buprenorphine and follow the patient’s progress. Organizations that implement buprenorphine in new settings, such as emergency departments or prisons, often cite the limited availability of warm handoff partners in their vicinity.
Insurance coverage for prescribed buprenorphine has been cited as a barrier to its use, either from non-coverage of buprenorphine or cumbersome requirements for prior authorization. Fortunately, there has been a steady increase in the number of payers that cover buprenorphine prescriptions, partly due to many states enacting legislation mandating insurance coverage of buprenorphine and prohibiting prior authorizations for buprenorphine.
Like other prescription medications, buprenorphine is prescribed by a healthcare provider but must be filled by the patient at a retail pharmacy. Some pharmacies do not have buprenorphine available or do not carry buprenorphine, and in one national secret shopper study, only 58% of pharmacies reported having buprenorphine for dispensing.
Facilitators
Prior to 2023, a major barrier to buprenorphine prescribing was the regulatory requirement for healthcare providers to undergo 8-24 hours of additional training and apply for a special “X-waiver” to prescribe buprenorphine. Additional regulations also limited the number of patients for whom each healthcare provider could prescribe buprenorphine. Both of these regulations were removed in January 2023, and now any healthcare provider with a DEA license can prescribe buprenorphine.