Study Shows Prior Authorization Did Not Improve Long-Term Treatment Retention of Buprenorphine

A recent study published in JAMA Health Forum reveals that state-level legislative bans on insurance prior authorization for buprenorphine have failed to significantly improve long-term treatment retention for privately insured patients. For pharmacists on the front lines of the opioid crisis, these findings suggest that removing administrative red tape is only one small piece of a much larger puzzle in maintaining patient adherence to medications for opioid use disorder (MOUD).¹

The investigation, which analyzed data from over 22,000 patients between 2015 and 2022, found that only 30.4% of individuals starting buprenorphine remained on treatment for the federally recommended minimum of 180 days. Despite 19 states implementing laws during the study period to prohibit private insurers from requiring prior authorization, researchers found no statistically significant change in whether a patient reached that 6-month threshold. Even when the researchers loosened the definition of retention to allow for 30-day gaps in medication, less than half of the patients remained in treatment.^1,2

“As more states enact prior authorization prohibitions to facilitate access to life-saving medications for opioid use disorder, our findings suggest that effective strategies will have to address multiple and interacting barriers such as requiring drug testing, counseling or quantity limits for medication,” Yuhua Bao, PhD, professor of population health sciences at Weill Cornell Medical College, said in a news release.²

These barriers often include insurance-mandated drug testing, quantity limits, and requirements for concurrent psychosocial counseling, all of which can interrupt a patient’s journey even if the initial prior authorization is waived. Furthermore, unlike Medicare Part D—which saw an increase in buprenorphine use following similar federal mandates—private insurance plans often lack the transparency needed for states to effectively monitor and enforce compliance with these bans.¹

The role of the pharmacist is becoming increasingly central to this public health challenge, particularly as access to the medication remains inconsistent. Although policymakers have eased prescribing rules, such as the 2023 elimination of the X-waiver, a separate study led by the USC Schaeffer Center found that buprenorphine was available at only 39% of retail pharmacies nationwide in 2023. This limited availability was even more pronounced in minority communities, with pharmacies in predominantly Black and Latino neighborhoods being significantly less likely to carry the treatment compared to those in white neighborhoods.^3,4

Pharmacists often find themselves caught between the clinical needs of their patients and the regulatory pressures of dispensing controlled substances. Many pharmacies may be hesitant to stock or dispense buprenorphine due to fears of running afoul of the federal Controlled Substances Act or facing scrutiny from the Drug Enforcement Agency (DEA). When demand for the medication rises, suppliers may pause shipments to avoid triggering DEA flags, leading to stockouts that directly impact patient retention.³

Despite these hurdles, the landscape for pharmacy practice is shifting toward greater intervention authority. The 2025 SUPPORT for Patients and Communities Reauthorization Act created a federal pathway for pharmacists to prescribe buprenorphine directly to patients, provided they meet a triple-lock of requirements: state authorization, an active DEA registration, and specialized buprenorphine-specific training. This landmark legislation positions pharmacists as the most accessible healthcare providers to initiate and manage treatment, particularly in rural or underserved areas where traditional physician visits may be difficult to secure.⁴

Pharmacists are also uniquely positioned to detect early signs of OUD because they see patients more frequently than most physicians. By monitoring for early refills or high-dose prescriptions, pharmacists can intervene early, offering rescue medications like naloxone and supporting patients through their recovery journey.⁴

However, the JAMA Health Forum study suggests that for these new prescribing powers to truly improve patient outcomes, they must be supported by broader policy actions that address the underlying stigma and the many secondary administrative hurdles that still exist within the private insurance market.^1,2

“Our study provides timely and policy-relevant evidence to help address persistent gaps in opioid use disorder treatment,” Allison Ju-Chen Hu, PhD, assistant professor at Tulane University School of Public Health and Tropical Medicine, said in the news release.² “Without robust enforcement and monitoring of private insurers’ compliance—in addition to the implementation of complementary interventions—legislative bans on prior authorization may have limited impact on closing treatment gaps.”

READ MORE: Mental and Behavioral Health Resource Center

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REFERENCES

1. Hu JC, Kapadia SN, Zhang H, et al. State Prior Authorization Prohibitions and Buprenorphine Retention Among Privately Insured Patients. JAMA Health Forum. 2026;7(3):e260012. Published 2026 Mar 6. doi:10.1001/jamahealthforum.2026.0012

2. Prior authorization bans for buprenorphine alone may not improve treatment retention. News release. Weill Cornell Medicine. March 6, 2026. Accessed March 6, 2026. https://news.weill.cornell.edu/news/2026/03/prior-authorization-bans-for-buprenorphine-alone-may-not-improve-treatment-retention

3. Despite relaxed prescribing rules, opioid addiction treatment still hard to find at pharmacies. News release. USC Schaeffer Center. September 2, 2025. Accessed March 6, 2026. https://schaeffer.usc.edu/research/opioid-treatment-buprenorphine-access-pharmacies/

4. National Association of Board of Pharmacy. The pathway for pharmacists to prescribe buprenorphine directly to patients. February 26, 2026. Accessed March 6, 2026. https://nabp.pharmacy/news/blog/the-pathway-for-pharmacists-to-prescribe-buprenorphine-directly-to-patients/