| Course | NURS 8100 Healthcare Policy and Analysis |
|---|---|
| Week | Week 3 |
| Paper type | Policy issue justification |
| Length | About 1,000 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NURS 8100 Week 3
One Issue, Four Reasons: Justifying Medicaid Prior Authorization for Buprenorphine as the Subject of a Staged Policy Analysis
Student Name
College of Nursing, Walden University
NURS 8100: Healthcare Policy and Analysis
Instructor Name
Month Day, Year
One Issue, Four Reasons: Justifying Medicaid Prior Authorization for Buprenorphine as the Subject of a Staged Policy Analysis
The Issue
This analysis will examine one policy: the requirement, in a composite state's Medicaid program, that prescribers obtain prior authorization before buprenorphine can be dispensed to adults with opioid use disorder. The population is adults enrolled in Medicaid with a diagnosis of opioid use disorder, a group that includes many of the state's residents at highest risk of overdose. The policy is governed by the state Medicaid agency, which sets pharmacy rules for its fee-for-service program and writes them into contracts with the managed care plans that cover most enrollees. The author is a composite psychiatric mental health nurse practitioner who prescribes buprenorphine in a community clinic and has watched patients leave the clinic without medication while an approval is pending.
Narrowing the issue this far is deliberate. Opioid use disorder policy is vast, and an analysis of all of it would describe much and decide nothing. A single rule, in a single program, with a single governing agency, can be analyzed from problem through recommendation within one course.
Framing the Issue as a Causal Story
Stone (1989) argued that problems do not arrive on the policy agenda already defined. They are framed through causal stories, accounts of what causes harm and who is responsible, and the story a problem is given shapes which solutions seem reasonable. A prior authorization rule can be told as more than one story.
The story the agency has told is one of stewardship: prior authorization protects patients and the program by ensuring medication is prescribed appropriately, limiting diversion and controlling cost. The story this analysis will test is different: an approval step delays the start of treatment at the moment a patient is ready, and the delay, not the medication, causes harm, since patients who leave without medication may return to illicit opioid use. Stone (2012) would call this a shift from an accidental or intended cause to a mechanical one, in which a routine procedure produces harm no one intends. The analysis will not assume the second story is correct. It will treat it as a claim to be tested against evidence and against the agency's own account.
Why This Issue: Four Grounds
1. Significance. Opioid overdose remains a leading cause of preventable death, and buprenorphine is an effective treatment. Anything that delays its start for people who are ready deserves scrutiny. For a Medicaid population, where many enrollees face barriers to returning for a second visit, a delay measured in days can mean treatment that never begins.
2. A changed policy environment. Federal law removed the separate federal waiver that clinicians once needed to prescribe buprenorphine (Consolidated Appropriations Act, 2023, Pub. L. No. 117-328). That change expanded the number of clinicians who can prescribe and weakened one of the traditional justifications for tight state controls. A state prior authorization rule designed for the earlier environment is now worth reexamining.
3. Evidence exists but is mixed. The issue can be analyzed with real evidence rather than opinion. Among Medicare Part D plans, removing prior authorization for buprenorphine-naloxone was associated with more prescriptions filled and with fewer adverse outcomes such as related hospital admissions (Mark et al., 2020). Among state Medicaid programs, one study found that removing prior authorization was associated with a significant increase in buprenorphine fills in one of two states studied but not the other (Keshwani et al., 2022). Mixed evidence is an advantage for a doctoral analysis, because it demands judgment rather than advocacy.
4. A decision point within reach. The rule is set by a state agency, not by federal statute, so it can be changed by an agency decision and contract amendments, or by state legislation. There are identifiable decision makers, and a nurse practitioner has standing as a prescriber who works within the rule every week.
Objections to the Choice
Three objections to this choice deserve answers before the analysis begins. The first is that the issue is too small: one pharmacy rule in one program seems minor beside the national overdose crisis. The answer is that small rules are where policy meets patients. A clinician can do everything right and still watch a patient leave without medication because an approval has not come back, and that moment is repeated every day in programs that keep the rule.
The second objection is that the issue is already decided, since several states have removed prior authorization for buprenorphine. That makes the analysis more useful, not less, because it can draw on those states' experience. It also raises a sharper question: if removal produced a clear increase in treatment in one state and not in another, what conditions made the difference, and does this state resemble one or the other?
The third objection is that the author's clinical position creates bias. It does, and the analysis will manage it by stating the agency's causal story fairly, using criteria defined before options are compared and treating an option to keep the rule as a real alternative. A prescriber's experience is a reason to study the rule closely; it is not evidence about how the rule performs across the program.
What the Analysis Will and Will Not Do
The analysis will proceed in stages across the course: stakeholders and their power, options and criteria, a recommendation with an implementation plan, a legislative strategy and a brief for the decision maker. It will not examine buprenorphine's clinical effectiveness, which is well established, nor other medications for opioid use disorder, which have different regulatory histories. It will not assume that removing prior authorization is the answer; one option the analysis must consider seriously is keeping the rule with faster decisions. By justifying the issue now, the analysis commits to a question narrow enough to answer and important enough to be worth answering. Every later stage will be judged against this choice, so any shift in scope will be stated openly rather than allowed to drift.
References
Consolidated Appropriations Act, 2023, Pub. L. No. 117-328, 136 Stat. 4459 (2022).
Keshwani, S., Maguire, M., Goodin, A., Lo-Ciganic, W.-H., Wilson, D. L., & Hincapie-Castillo, J. M. (2022). Buprenorphine use trends following removal of prior authorization policies for the treatment of opioid use disorder in 2 state Medicaid programs. JAMA Health Forum, 3(6), Article e221757. https://doi.org/10.1001/jamahealthforum.2022.1757
Mark, T. L., Parish, W. J., & Zarkin, G. A. (2020). Association of formulary prior authorization policies with buprenorphine-naloxone prescriptions and hospital and emergency department use among Medicare beneficiaries. JAMA Network Open, 3(4), Article e203132. https://doi.org/10.1001/jamanetworkopen.2020.3132
Stone, D. (2012). Policy paradox: The art of political decision making (3rd ed.). W. W. Norton.
Stone, D. A. (1989). Causal stories and the formation of policy agendas. Political Science Quarterly, 104(2), 281-300. https://doi.org/10.2307/2151585
What the NURS 8100 Week 3 instructions ask for
Issue justification assignments usually ask you to choose the policy issue your analysis will examine for the rest of the course and to defend that choice. Expect about three pages. Name the issue precisely: the population, the rule and who has authority over it. Explain why you narrowed it, since broad issues stall later stages. Frame the issue with a recognized approach, such as Stone's causal stories, stating the competing stories fairly. Give several grounds for the choice, each answering a different question a reviewer might ask. Anticipate objections, including your own potential bias. Close by describing what the analysis will and will not do, so later stages have a boundary to respect.
Inside the NURS 8100 Week 3 example
The first section names the Medicaid rule, the population and the author's position, and explains the narrow scope. A framing section cites Stone's 1989 article and her later book to contrast two causal stories and commits to testing the second. Four grounds follow: significance, the federal change cited to the Consolidated Appropriations Act of 2023, evidence cited to Mark and colleagues and Keshwani and colleagues and a decision point held by the agency. A section answers objections that the issue is too small, already decided or biased by the author's role. A closing section sets the analysis's scope. The last section fixes what later stages may and may not add.
Where the marks sit in the NURS 8100 Week 3 rubric
Justifications are generally graded on precision, framing, the strength of the grounds and awareness of limits. Precision earns credit when the issue names a population, a rule and an authority. Framing is rewarded when competing stories are presented fairly. Grounds score well when each addresses a distinct question, such as significance, timing, evidence and feasibility. Faculty value mixed evidence handled honestly more than one-sided citation. Anticipating objections, including bias, shows maturity. A clear statement of scope protects later stages. APA citations of legal and scholarly sources and a concise structure complete the typical rubric for this staged assignment. Some instructors add credit when the writer names a way to manage personal bias.
NURS 8100 Week 3 help from the desk
Justifications lose marks when the issue is too broad, such as the opioid crisis, to support a single analysis. Another common loss is framing that presents only the author's story. Some papers offer grounds that all say the issue is important in different words. Others cite only studies that support the author's view. Name a narrow issue with a clear authority, frame competing stories fairly, give distinct grounds, handle mixed evidence honestly, answer objections and set boundaries. The desk can draft a justification for the issue you choose. Check that a named body can actually act on your issue before you commit to it. Write the objections before your grounds, then check that the grounds answer them.
Get a NURS 8100 Week 3 example written to your instructions
Share your Week 3 prompt and rubric, plus the issue you are leaning toward if you have one, and a NURS 8100 policy issue justification is built to carry the staged analysis after it. Free on a first request; 24 to 48 hours. The Medicaid program and prescriber here are composites, so none of your employer's data is involved.
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NURS 8100 Week 3 questions, answered
Why justify an issue instead of simply naming it?
Because the staged analysis depends on the choice. An issue lacking a body with authority to act, realistic alternatives or a link to nursing practice will stall by the stakeholder or alternatives week. The justification shows the issue can carry the whole sequence. The example argues tractability at the greatest length for that reason, since it predicts whether your final brief can recommend something a real body could adopt.
What does Deborah Stone contribute to issue framing?
Stone argues that defining a policy problem is itself political, often done through causal stories that assign cause and, by extension, responsibility. The example uses the idea narrowly: it states the causal story its analysis will test, that an approval step delays the first dose. Naming the story openly lets later stages confirm or revise it rather than assuming it silently.
How narrow should the issue be for a doctoral analysis?
Narrow enough that one body can act on it. The example moves from the opioid crisis, too broad for any single decision, to one pharmacy rule in one state Medicaid program, which the agency controls. That narrowing does not shrink the significance; it gives the significance a lever. If your section requires a federal issue, the same test applies at that level.
Where can I find a free NURS 8100 Week 3 sample paper?
The whole issue justification, scope, framing, four grounds and objections, is here to read in full at no charge. A justification for your own policy issue can be requested.
What two causal stories does the NURS 8100 Week 3 paper compare?
The agency's stewardship story, in which review protects patients and the program, and a delay story, in which the approval step itself holds up treatment when a patient is ready.