County-level access to opioid use disorder medications in medicare Part D (2010-2015)

Health Serv Res. 2019 Apr;54(2):390-398. doi: 10.1111/1475-6773.13113. Epub 2019 Jan 21.


Objective: To identify geographic disparities in access to opioid use disorder (OUD) treatment medications and county demographic and economic characteristics associated with access to buprenorphine and oral naltrexone prescribers in Medicare Part D.

Data sources/study setting: We utilized data from the Medicare Part D Prescription Drug Event Standard Analytic File (2010-2015).

Study design/data collection: We used logistic regression to examine county-level access to OUD medication prescribers.

Principal findings: There was a 5.6 percentage point increase in counties with access to an OUD prescriber over the study period. However, in 2015, 60 percent of US counties lacked access to a Medicare Part D buprenorphine prescriber and over 75 percent lacked access to an oral naltrexone prescriber. Increased access to OUD prescribers was largely concentrated in urban counties. Results of logistic regression indicate regional differences and potential racial disparities in access to OUD prescribers.

Conclusions: To improve access to buprenorphine and naltrexone treatment for Medicare Part D enrollees, CMS may consider implementing educational and training initiatives focused on OUD treatment, offering training to obtain a buprenorphine waiver at no cost to providers, and sending targeted information to providers in low OUD treatment capacity areas.

Keywords: access; buprenorphine; medicare; naltrexone; opioid use disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Buprenorphine / administration & dosage
  • Buprenorphine / therapeutic use*
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Logistic Models
  • Medicare Part D / statistics & numerical data*
  • Naltrexone / administration & dosage
  • Naltrexone / therapeutic use*
  • Opiate Substitution Treatment / methods
  • Opiate Substitution Treatment / statistics & numerical data*
  • Opioid-Related Disorders / drug therapy*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Residence Characteristics
  • Socioeconomic Factors
  • United States


  • Buprenorphine
  • Naltrexone