Objective: This study was completed as a follow up to research regarding buprenorphine Medication Assisted Therapy (MAT) in Johnson City Tennessee for-profit clinics. We wished to determine the practice patterns over the last three years. Methods: Johnson City for-profit Medical Assisted Therapy clinics were called with a telephone survey. When the clinic representative answered the phone, they were asked questions regarding patient costs for therapy, insurance coverage, counseling offered on site, and opportunities for tapering while 20 weeks pregnant. Results: At all the MAT clinics contacted, the representative informed us that tapering in pregnancy could be considered contrary to current national guidelines. 43% of the clinics are now accepting insurance as compared to 0% in the 2016 study. The average weekly cost per visit remained consistent. Conclusion: The concept of tapering buprenorphine during pregnancy appears to have become a standard of care for this community and it is offered at all of the clinics that were contacted, some even require it, even though national organizations such as American College of Obstetricians and Gynecologists and American Society of Addiction Medicine; do not recommend this approach. Patients who have insurance including government funded insurance, are now able to obtain buprenorphine with no out of pocket expense at numerous clinics. The high cost for the uninsured patient continues to create an environment conducive to buprenorphine diversion.

Objectives This study was undertaken to confirm that patient reports on buprenorphine medication-assisted therapy in for-profit buprenorphine clinics in our community were personally costly. We contacted all 17 for-profit clinics in our community and confirmed the patient reports that a significant financial payment of ≤$100 was required for each visit. We also found that tapering of buprenorphine dosage in pregnancy was offered by several of the clinics. Methods A telephone survey was conducted with the 17 for-profit buprenorphine clinics located in the Johnson City, Tennessee area. The clinic representative who answered the telephone was asked questions regarding patient costs for therapy and availability of tapering programs for pregnant women. Results Patient reports that the for-profit clinics are costly were confirmed. None of the clinics accepted insurance reimbursement of any type. The most common weekly costs were $100 per visit. A majority of clinics offered biweekly or monthly visits at significantly increased rates. Clinic representatives stated that a majority of clinics would consider buprenorphine tapering programs for pregnant women. Conclusions The high cost of for-profit clinics is a barrier for patient access to medication-assisted therapy with buprenorphine. Tapering of buprenorphine dosage in pregnant women has penetrated buprenorphine management practice in our community. Further research is needed to determine whether elimination of cost barrier would have a positive effect on the rates of neonatal abstinence syndrome.