We've X'd The X Waiver: Now What?

Courtney Gallo Hunter, VP, State Policy
A close up of a man's hands signing paperwork

Short-term crises, like the COVID-19 pandemic, often present opportunities for long-term change and reform. That rung true this week when a long-overdue policy change was enacted by the U.S. Department of Health and Human Services: eliminating the special waiver requirement, known as the X-Waiver, for physicians to prescribe buprenorphine

The evidence is clear that medications for addiction treatment are the gold standard of care. They are one of the strongest tools to combat the opioid crisis and yet, access has been hamstrung for the past 20 years as overdose deaths have continued to skyrocket. COVID-19 has only exacerbated the addiction crisis with challenges to treatment access, isolation and joblessness. 

Prior to the pandemic, our report on buprenorphine access illustrated that less than 6% of providers are waived to prescribe the medication, resulting in major access challenges. This access disparity became even greater during the pandemic. 

X’ing the X-Waiver is a tremendous step forward to bridge this treatment access gap. However, it is not without its own restrictions. Under the new practice guidelines, physicians are limited to treating no more than 30 patients with buprenorphine at any one time, unless they are emergency room doctors. This rule change only applies to buprenorphine and has no impact on methadone prescribing practices. It additionally only applies to physicians, not physician assistants or nurse practitioners. Those providers can still prescribe buprenorphine, but only if they obtain the special waiver.

This policy change is a major development that will undoubtedly save lives. However, we still need to advocate for permanent changes to the requirement and for widespread addiction training and education. Even without the waiver requirement, doctors that are not trained in addiction might be wary or unprepared to treat patients with opioid use disorder. This policy change encourages a renewed push for the Medication Access and Training Expansion (MATE) Act, to ensure a base-level knowledge of how to prevent and treat addiction. Contact your representatives now and urge them to support the MATE Act, which will bring our country one step closer to aligning addiction treatment  with mainstream health care. 


Courtney Gallo Hunter is Shatterproof's Vice President of State Policy.