23rd Annual Pain Medicine Meeting 2024

Unrestricted Insurance Coverage of On-Label Buprenorphine Formulations Remains Sparse in Comparison to Conventional Opioids

Taif Mukhdomi MD1 , Bennett Andrassy1 , Nidhi Bhaskar2 , Marcus Harris MD1 , Junaid Mukhdomi MD1 1 Pain Labs, New Albany, OH, USA 2 Warren Alpert Medical School of Brown University, Providence, RI, USA

Background

Buprenorphine has a more favorable safety profile than conventional opioids or tramadol [1,2], with equal or superior analgesic efficacy [3,4].

It was reported in 2019 that access to on-label buprenorphine formulations was limited in comparison to conventional opioids [5], despite evidence supporting buprenorphine use as a first-line analgesic.

In light of policy changes increasing buprenorphine accessibility, we sought to determine differences in unrestricted health insurance coverage between on-label buprenorphine formulations, conventional opioids, and tramadol.

Methods

We used data from Managed Market Insights and Technology’s Coverage Search application and the KFF Health Insurance Coverage of the Total Population page to estimate percentages of US covered lives with unrestricted access to oxycodone instant release, morphine extended release, tramadol (oral), transdermal buprenorphine (Butrans, Purdue Pharma), buprenorphine buccal film (Belbuca, Endo Pharmaceuticals), and sublingual buprenorphine/naloxone (Suboxone, Indivior).

Discussion Points

Generic buprenorphine formulations are entering the market.
There is no generic formulation for buccal buprenorphine, which is considered safest and most effective for pain management.
Barriers to buprenorphine access include cost, dose limits, prior authorization/step edit requirements, and mandatory drug screenings.
No plans in Maine, Massachusetts, Mississippi, New Hampshire, or Rhode Island provide unrestricted access to Butrans.

Conclusion

Health insurance restrictions for on-label buprenorphine coverage exceed those of more dangerous opioids, contradicting scientific consensuses, and needlessly endangering patients. We recommend the expeditious removal of such restrictions.

References

[1] Hale M, Garofoli M, Raffa RB. Benefit-risk analysis of Buprenorphine for pain management. J Pain Res. 2021;Volume 14:1359-1369. doi:10.2147/jpr.s305146

[2] Webster LR, Cater J, Smith T. Pharmacokinetics of buprenorphine buccal film and orally-administered oxycodone in a respiratory study: An analysis of secondary outcomes from a randomized controlled trial. Pain and Therapy. 2022;11(3):817-825. doi:10.1007/s40122-022-00380-2

[3] Pergolizzi JV, Raffa RB. Safety and efficacy of the unique opioid buprenorphine for the treatment of chronic pain. J Pain Res. 2019;12:3299-3317. doi:10.2147/jpr.s231948

[4] Webster L, Gudin J, Raffa RB, et al. Understanding buprenorphine for use in chronic pain: Expert opinion. Pain Med. 2020;21(4):714-723. doi:10.1093/pm/pnz356

[5] Fishman MA, Scherer A, Topfer J, Kim PS. Limited access to on-label formulations of buprenorphine for chronic pain as compared with conventional opioids. Pain Med. 2019;21(5):1005-1009. doi:10.1093/pm/pnz197

23rd Annual Pain Medicine Meeting 2024

UNRESTRICTED INSURANCE COVERAGE OF ON-LABEL BUPRENORPHINE FORMULATIONS REMAINS SPARSE IN COMPARISON TO CONVENTIONAL OPIOIDS

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