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Extended-release prescription medications to treat opioid use disorder (MOUDs) offer long-acting, first-line treatment options for people with opioid use disorder (OUD). These long-acting medications could help retain more people in treatment and help people manage their day-to-day lives successfully—an even more urgent issue in light of the coronavirus pandemic. Three extended-release MOUDs—Vivitrol, Probuphine, and Sublocade—have entered the market in recent years, but there is little information about how many Medicaid enrollees receive long-acting MOUD across state Medicaid programs and what the net cost is for Medicaid after adjusting for federal rebates. We analyze Medicaid State Drug Utilization Data from 2011 to 2018 and find the following:

• Medicaid enrollees rarely receive extended-release buprenorphine (Probuphine and Sublocade), but use of extended-release naltrexone (Vivitrol) is extensive.
• Our estimates of the federal rebates from manufacturers lowered states’ net drug costs substantially in 2018. Adjusting for federal rebates, cost per prescription decreased from $1,206 to $589 for Vivitrol, from $1,522 to $1,147 for Sublocade, and from $2,650 to $2,038 for Probuphine. Accounting for these rebates may improve the cost effectiveness of extended-release MOUDs.

Additionally, in light of the coronavirus pandemic and related barriers to and risks of face-to-face interaction and daily or frequent office visits, health care providers and Medicaid patients on short-acting MOUDs could consider whether extended-release treatments provide more stable medication therapy.

This report is part of a larger project, Tracking Medicaid-Covered Prescriptions to Treat Opioid Use Disorder. Click here to learn more.

This report was updated April 15, 2020, to remove "per 1,000 Medicaid enrollees" from the title of figure 3 (page 12); the title now correctly describes the total numbers of Sublocade prescriptions across the US in 2018 by state quartile.