Study Reveals a Widening Gap Between Buprenorphine Prescribing and Dispensing

Despite federal efforts to broaden buprenorphine prescribing, a growing share of patients may never receive their first dose. A retrospective cohort study published in JAMA Network Open found that abandonment of a first buprenorphine prescription for opioid use disorder (OUD) increased from 19% in 2020 to 37% in 2024 (P for trend = .02).¹ The finding places renewed attention on the handoff from prescribing to dispensing—and on pharmacists’ ability to identify and resolve barriers before treatment initiation is lost.

A Critical Gap After Prescribing

Buprenorphine is 1 of 3 FDA-approved medications for OUD, alongside methadone and naltrexone.² Yet treatment remains markedly underused. CDC investigators estimated that only 25.1% of US adults who needed OUD treatment in 2022 received medication.³ The new analysis suggests that increasing the number of eligible prescribers, although important, does not guarantee that medication reaches patients.

Investigators linked electronic health record and administrative claims data from the Optum Labs Data Warehouse. The cohort included 1428 commercially insured or Medicare Advantage adults whose first buprenorphine prescription for OUD was written between January 1, 2020, and September 25, 2024. Abandonment was defined as no dispensing claim within 30 days, including prescriptions not picked up by patients or rejected by an insurer or pharmacy.¹

Overall, 369 patients (25.8%) abandoned the prescription, whereas 1059 (74.2%) had it dispensed. The abandonment group was younger on average (54.3 vs 57.4 years), included a larger proportion of Hispanic patients (10.6% vs 4.8%), and was more likely to have commercial insurance (51.8% vs 29.4%). Mean pharmacy deductibles were also higher among patients whose prescriptions were abandoned ($483.80 vs $296.40).¹

Cost Is Part of a Larger Access Problem

The deductible finding is notable, but it should not be interpreted as proof that cost caused abandonment. The investigators reported no statistically significant difference in tier 2 retail copays, and their data could not distinguish patient nonpickup from insurer or pharmacy rejection.¹ Prior research involving millions of retail pharmacy transactions found only a small association between each $10 increase in cost sharing and abandonment, supporting a multifactorial response rather than a cost-only solution.⁴

The study also cannot establish whether rising abandonment reflected inventory gaps, prior authorization or quantity limits, stigma, transportation, language discordance, competing clinical needs, or patient preference. Cash purchases and fills billed to another insurer may have been missed. Generalizability is additionally limited because the cohort excluded Medicaid recipients and uninsured patients.¹

Pharmacists Can Protect the First Fill

For community, health-system, and oncology pharmacists, a first buprenorphine prescription should be treated as a time-sensitive transition of care. Practical steps can include confirming local inventory before discharge, rapidly clarifying rejected claims, identifying deductible exposure, connecting patients with an in-network pharmacy, and communicating unresolved barriers to the prescriber. A same-day callback after a rejection can help distinguish an administrative delay from a patient decision not to begin therapy. Language-concordant counseling and a nonjudgmental explanation of buprenorphine’s role may be especially important when trust or stigma threatens initiation. In oncology settings, pharmacists can help align OUD treatment with pain and supportive care plans, so a dispensing problem does not fragment care.

Health systems can also track “prescribed but not dispensed” buprenorphine as an access metric, establish closed-loop referral workflows, and consider direct dispensing during eligible clinical encounters. The study’s message is straightforward: prescribing capacity matters, but success should be measured by whether the patient actually starts treatment. Pharmacists are positioned at that decisive last mile.

REFERENCES

1. Jiang X, Zhang K, Chen Y, et al. Abandonment of prescribed buprenorphine for opioid use disorder, 2020-2024. JAMA Netw Open. 2026;9(8). doi:10.1001/jamanetworkopen.2026.27142

2. US Food and Drug Administration. Information about medications for opioid use disorder (MOUD). Published December 26, 2024. Accessed August 7, 2026. https://www.fda.gov/drugs/food-and-drug-administration-overdose-prevention-framework/information-about-medications-opioid-use-disorder-moud

3. Dowell D, Brown S, Gyawali S, et al. Treatment for Opioid Use Disorder: Population Estimates - United States, 2022. MMWR Morb Mortal Wkly Rep. 2024;73(25):567-574. Published 2024 Jun 27. doi:10.15585/mmwr.mm7325a1

4. Chua KP, Conti RM, Lagisetty P, Bohnert ASB, Nuliyalu U, Nguyen TD. Association Between Cost-Sharing and Buprenorphine Prescription Abandonment. J Gen Intern Med. 2024;39(12):2160-2168. doi:10.1007/s11606-024-08819-2