Changes in Buprenorphine-Naloxone and Opioid Pain Reliever Prescriptions After the Affordable Care Act Medicaid Expansion

Key Points Question Did Medicaid expansion under the US Affordable Care Act change prescription fills for buprenorphine with naloxone, a treatment for opioid use disorder, and opioid pain relievers? Findings In this cohort study using difference-in-differences analysis of all-payer prescription fill data from 5 states, Medicaid expansion was associated with a significant overall increase in people filling prescriptions for buprenorphine with naloxone. Expansion was not associated with changes in fills per 100 000 county residents of opioid pain relievers overall, but significantly more people filled prescriptions for opioid pain relievers paid for specifically by Medicaid. Meaning Medicaid expansion may increase the role of states in providing opioid use disorder treatment and in paying for opioid pain relievers for pain management.