Buprenorphine Treatment Following the 2025 Telehealth Policy Transition

Telehealth policies during the pandemic shifted healthcare delivery by permitting reimbursement for encounters via synchronous audio-video or audio modalities. As broader telehealth flexibilities from the Continuing Appropriations Act expired, targeted extensions remained for buprenorphine treatment. Social vulnerability index (SVI) is a proxy of social determinants of health. This study examined the use of telehealth in buprenorphine prescribing encounters and assessed for potential disparities in access to telehealth via stratification by social vulnerability index (SVI).

Using a large, multi-institutional electronic health record dataset of 300m+ patients (Epic Cosmos), we examined encounters with buprenorphine orders from 01/2017-11/2025. Encounters were classified as telehealth or non-telehealth. Utilization was stratified by SVI quintiles which were inferred based on the patient’s last known residential address and proportional differences were compared to assess equity.

We identified 11,797,999 buprenorphine-associated encounters among 1,653,294 unique patients. Telehealth accounted for 46.1% (95% CI: 46.11, 46.16) of encounters, and 57.9% of patients had at least one telehealth visit. Among the telehealth encounters, mean age was 50.8 (SD 15.3), 49.2% male and 50.8% female. Telehealth utilization by SVI quintile was 46.1% (95% CI: 46.08, 46.21) in Q1 (least vulnerable), 46.2% (46.18, 46.30) in Q2, 46.5% (46.43, 46.56) in Q3, 47.9% (47.83, 47.93) in Q4, and 44.5% (44.40, 44.53) in Q5 (most vulnerable). A Cochran-Armitage test identified a statistically significant monotonic decrease in telehealth utilization across increasing SVI quintiles (p < 0.001).

Telehealth utilization varied moderately across SVI quintiles, increasing slightly across Q1 – Q4 before declining in the most vulnerable communities (Q5). While a statistically significant monotonic trend was observed, differences were small, suggesting broad system-wide telehealth uptake. These findings suggest the need for sustained telehealth policies to support treatment continuity and equitable access as federal flexibilities evolve.