Buprenorphine prescribing is increasingly delivered by primary care nurse practitioners to Medicaid beneficiaries.

BACKGROUND: Medicaid beneficiaries have disparate access to buprenorphine, a lifesaving medication for opioid use disorder (OUD) that can be prescribed in primary care settings. Nurse practitioners (NPs) are a growing primary care workforce, but their buprenorphine prescribing habits compared with physicians and the impact of recent policy changes on their practice is unknown.

PURPOSE: To characterize buprenorphine prescribing by primary care NPs and physicians to Medicaid beneficiaries with OUD and to examine the impact of the removal of the buprenorphine waiver on prescribing behavior.

METHODS: A retrospective analysis was conducted using Medicaid prescription data from Philadelphia between 2017 and 2023. Descriptive statistics along with t -tests were conducted to analyze the data. Clinical complexity was measured by presence of comorbidities indicating more severe OUD (e.g., hepatitis C, wounds).

RESULTS: Primary care NPs became the largest group of buprenorphine prescribers to Medicaid beneficiaries with OUD by 2023. Both physicians and NPs treated patients with similar levels of clinical complexity. The removal of the X-waiver was not associated with significant changes in buprenorphine prescribing rates for either provider type.

CONCLUSIONS: NPs play a critical role in expanding access to buprenorphine treatment for Medicaid patients with OUD. Similar patient complexity across providers supports the potential for broader NP involvement in OUD care. The lack of change after X-waiver removal suggests that other factors influence prescribing practices.