Writing the prescription isn't enough for buprenorphine treatment

Clinical takeaway: Following up early after prescribing buprenorphine can help confirm that the medication was obtained and identify pharmacy, insurance, cost, or communication barriers that may prevent patients from starting treatment.

Federal policy changes have made it easier for clinicians to prescribe buprenorphine for opioid use disorder. But prescribing alone does not start treatment. Patients must still obtain the medication, and the growing number of first prescriptions that are never dispensed suggests that access is breaking down after the clinical decision has already been made.

That breakdown has become more common. In a linked claims study, researchers classified first buprenorphine prescriptions as abandoned when claims showed no dispensing within 30 days, including prescriptions patients did not fill and those rejected by insurers or pharmacies. The proportion meeting that definition almost doubled from 19% in 2020 to 37% in 2024. Across the full study period, more than one-quarter of patients had an abandoned prescription.

To examine where this gap may be occurring, the study linked electronic health records with administrative claims for more than 1,400 adults enrolled in commercial or Medicare Advantage plans. Each patient had received a first recorded buprenorphine prescription for opioid use disorder between January 2020 and September 2024.

Insurance coverage emerged as a key point of difference. About half of patients with abandoned prescriptions had commercial insurance, compared with about 3 in 10 whose prescriptions were dispensed. Average pharmacy deductibles were also nearly $200 higher among patients with abandoned prescriptions, about $480 compared with $300. Tier 2 retail pharmacy copays were similar between groups, suggesting that deductibles may have been more relevant than cost-sharing overall.

The gap also differed across patient groups. Hispanic patients made up about 1 in 10 of those with abandoned prescriptions, compared with about 1 in 20 of those whose prescriptions were dispensed. The authors noted that language barriers and limited pharmacy access in some communities could contribute to this disparity.

Recent clinical history also separated the groups. More than half of patients whose prescriptions were dispensed had a recent record of opioid use disorder or overdose or a mental health condition, compared with about 40% of patients whose prescriptions were abandoned. Records of another substance use disorder were also more common among patients who obtained the medication.

The study reframes an unfilled buprenorphine prescription as more than a missed pharmacy transaction. It may signal that treatment has stalled before the patient obtains the medication, whether because of insurance, cost, pharmacy access, communication, or another barrier. Starting care therefore depends not only on prescribing buprenorphine, but also on whether the patient can obtain it without delay.

Source: Jiang X, et al. (2026 Aug 4) JAMA Netw Open. Abandonment of prescribed buprenorphine for opioid use disorder, 2020-2024