Racial and Ethnic Minorities Less Likely to Get Buprenorphine Treatment Through Medicare

New research published in Health Affairs DataWatch shows persistent racial and ethnic disparities among Medicare beneficiaries who received buprenorphine for opioid use disorder (OUD).

Buprenorphine is a critical Food and Drug Administration-approved treatment for OUD because it can be prescribed in office-based settings and dispensed at pharmacies like any other medication. However, access to buprenorphine remains unequal across communities. Such disparities are worrisome given the continued rise in opioid overdose death rates, especially among African Americans.

The increasing rates of OUD among Medicare beneficiaries and the complex health needs of Medicare disability enrollees prompted researchers from Rutgers University, with support from The Pew Charitable Trusts, to examine racial and ethnic disparities in buprenorphine treatment among Medicare enrollees diagnosed with OUD or with a history of opioid overdose.  

Study findings

Using Medicare claims data from 2015 to 2019, researchers examined Medicare beneficiaries—people age 65 and older and also some ages 18-64 who qualify because of disability—who had been diagnosed with OUD or had a history of opioid overdose. Researchers found that, in general, White beneficiaries were more likely to receive buprenorphine than were racial and ethnic minorities.

Buprenorphine treatment among all Medicare disability beneficiaries increased from 2015 to 2019. However, in each year, racial and ethnic minorities received buprenorphine treatment at lower rates than did White beneficiaries. In fact, in 2015, buprenorphine treatment was statistically significantly lower among Black Medicare disability enrollees (4.8%) compared with their White counterparts (13%), a discrepancy that persisted throughout the study period.

Treatment with buprenorphine among Medicare beneficiaries age 65 and older also increased from 2015 to 2019, and treatment rates for Black and White beneficiaries were comparable from 2017 to 2019. However, Hispanic beneficiaries in this age group had statistically significantly lower buprenorphine treatment rates throughout the study period compared with White beneficiaries.

The research also showed that buprenorphine treatment among all Medicare beneficiaries varied across states. For example, in 33 states, Black beneficiaries with disabilities received buprenorphine at less than half the rate of White beneficiaries. There was also variability in buprenorphine treatment among Medicare beneficiaries age 65 and older. In this group, the Black-to-White buprenorphine treatment disparity ratio—the proportion of individuals receiving buprenorphine in each racial and ethnic group relative to that of White beneficiaries—was lower than 50% in 10 states, but no Black-to-White disparity ratio existed for 12 states.

Policies to improve equitable treatment access

In light of these findings, policymakers must continue to prioritize expansion of access to buprenorphine, especially for racial and ethnic minorities. The bipartisan Mainstreaming Addiction Treatment (MAT) Act, which was signed into law in December 2022, removes barriers to buprenorphine prescribing. But specific federal and state efforts are still needed to ensure that the medication reaches racial and ethnic minorities and individuals with disabilities:

• The federal government and states must collect and report data disaggregated by race and ethnicity. Doing so will help to identify communities most in need of services. Reporting aggregate data or adjusting for race and ethnicity without reporting on observed differences hides trends in subpopulations, which perpetuates inequities.
• Health care payers such as Medicare should incentivize programs and providers to reduce disparities. Health programs that have reduced or eliminated disparities in treatment can offer lessons to other health programs on how to close the disparity gap. Funding and insurance reimbursement should reflect the operational needs and training necessary for health programs to provide culturally and linguistically appropriate care and to recruit and retain diverse staff members who reflect the communities they serve.
• Federal and state policymakers should support buprenorphine prescribing initiatives. Such initiatives remove obstacles to treatment and can engage historically marginalized communities that may face barriers to accessing care in traditional health care settings. These approaches include eliminating insurance prior authorization requirements for prescribing buprenorphine, removing counseling requirements for patients receiving treatment, continuing COVID-19 era policies such as allowing telehealth visits to begin treatment, and funding social services that support initiation and continuation of care, such as transportation.

This research adds to an abundance of evidence showing that racial and ethnic disparities persist in access to buprenorphine despite national and state-level efforts to improve it. As a result, federal and state policymakers should consider targeted initiatives and policies at the population level to ensure that racial and ethnic minorities and people with disabilities have equitable access to this lifesaving medication.

Alexandra Duncan and Vanessa Baaklini work on Pew’s substance use prevention and treatment initiative.