Expanding Patient Access to Buprenorphine for Opioid Use Disorder Through Pharmacist Independent Prescriptive Authority.

Abstract

In the United States, despite evidence that medication treatment for OUD (MOUD) improves outcomes, buprenorphine MOUD (B-MOUD) treatment rates remain suboptimal. The Mainstreaming Addiction Treatment (MAT) Act, passed in 2022, removed federal prescribing restrictions which allowed any health care provider, including pharmacists, with a DEA (Drug Enforcement Administration) registration to prescribe B-MOUD unless otherwise restricted by their state of licensure. As of March 2026, only 16 states allow pharmacists to obtain DEA licensure for controlled substance prescriptive authority. The SUPPORT for Patients and Communities Reauthorization Act of 2025 indicates that pharmacists may prescribe B-MOUD independently where state law allows and sends a signal for states to align in this practice. Pharmacists have demonstrated the ability to provide comprehensive medication management in OUD treatment with positive outcomes of increased access, cost savings, reduced physician burden, enhanced medication utilization and adherence, improved treatment retention, and high patient satisfaction. Since implementation of the MAT Act, DEA-registered pharmacists in the Department of Veterans Affairs Veterans Health Administration (VHA) have independently prescribed B-MOUD. Clinical Pharmacist Practitioners (CPPs) within VHA practice as members of the interprofessional team and have independent prescriptive authority under a scope of practice based on their qualifications and competencies. This commentary describes CPP independent B-MOUD prescribing within VHA as an effective practice that could model pharmacist care in other large health care systems. Benefits of this model include increased B-MOUD access and retention while maintaining high quality, team-based care and use of telehealth to expand access to underserved areas. Major limitations include state legislative barriers that restrict pharmacist-controlled substance and B-MOUD prescribing. We call for advancements to state practice laws that authorize controlled substance prescriptive authority for pharmacists and reimbursement for services which are essential to continue expanding CPP B-MOUD prescribing within and beyond the VHA.