December 5, 2022 | Erin Bluvas, firstname.lastname@example.org
New research published in JAMA Health Forum has found that opioid use disorder treatment coverage and prior authorization varies widely from state to state for individuals insured by Medicaid. The research was led by health services policy and management associate professor Christina Andrews (Arnold School of Public Health, University of South Carolina), Amanda Abraham (School of Public and International Affairs, University of Georgia) and Colleen Grogan (Crown School of Social Policy and Practice, University of Chicago), who are co-principal investigators on two R01 grants from the National Institute of Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. Together, this $5 million in NIH funding is aimed at investigating Medicaid-covered treatment for alcohol and opioid use disorders.
“Opioid-related mortality reached an all-time high in 2021, exceeding 80,000 deaths,” Andrews says. “In 2020, approximately 2.5 million people met the criteria for opioid use disorder, but only 11 percent received any FDA–approved medications.”
These approved medications include buprenorphine, methadone and injectable naltrexone and have been proven to reduce opioid use, fatal overdoses and related health care visits while increasing treatment retention rates. Expanding access to treatment remains a public health priority, and Medicaid coverage is a key policy lever for achieving this goal. Approximately 40 percent of Americans who have opioid use disorder are covered by Medicaid, yet little is known about coverage and prior authorization policies for covering FDA-approved medications for treating the condition.
For this study, the researchers compared coverage and prior authorization policies for opioid use disorder medications in 266 managed care organization plans and 39 fee-for-service programs during the first half of 2018. Approximately 70 million Medicaid beneficiaries were represented by these plans/programs.
The team’s analyses found a wide variation in the plans and programs across states. Overall, fee-for-service programs had more generous coverage for opioid use disorder medications; however, a higher percentage of these programs required prior authorization for certain medications.
“The use of prior authorization can be effective to control costs and limit unnecessary care, but it can also unnecessarily restrict access to these important medications,” says Andrews, who notes that prior authorization practices can deny essential care or result in missed opportunities for patient engagement if decisions take too long.
“We also learned that Medicaid beneficiaries’ access to medications used to treat opioid use disorder may be heavily influenced by their state of residency and the Medicaid plan in which they are enrolled,” she adds. “Left unaddressed, prior authorization policies are likely to remain a barrier to opioid use disorder medication access in the midst of the deadliest drug epidemic in the nation’s history.”