ASAM Updates Report on Medicaid Coverage of Addiction Treatments

ASAM contracted the Treatment Research Institute (TRI) to update a June 2013 ASAM Patient Advocacy Task Force (PATF) survey and research report on insurance coverage of opioid addiction medications. The report assesses how Medicaid coverage of opioid addiction pharmacotherapies, both medication and counseling, across the United States, has changed over the last year.

To gather the most comprehensive, current Medicaid coverage information, survey questions included whether counseling and medications—methadone, Suboxone, buprenorphine/ naloxone tablets (Zubsolv and generic), buprenorphine tablets, and injectable naltrexone (Vivitrol)—were covered under each state’s Medicaid program. In addition, information was collected about each plan’s coverage limitations and barriers to access, such as the documentation requirements, prior authorizations, lifetime limits, and maximum daily medication dosages.  

While many states increased access to opioid addiction pharmacotherapies between 2013 and 2014, Delaware, Massachusetts and Texas made the most improvement. In Delaware, the lifetime limit on buprenorphine was doubled, rising from 12 to 24 months. Massachusetts made several changes to its Medicaid coverage over the last year that were positive, including removing the buprenorphine/ naloxone prior authorization requirement, except for doses over 32mgs and treatment beyond 180 days; increasing the maximum daily dose of buprenorphine after six months of therapy from 24 mg to 32mg; and reclassifying injectable naltrexone so that it is now covered as both a medical and pharmacy benefit. Texas also made several changes to its Medicaid coverage of addiction treatment: the prior authorization requirement for buprenorphine/naloxone was lifted; it began covering injectable naltrexone as a medical benefit; and buprenorphine/naloxone film was reclassified, so it’s now covered as both medical and pharmacy benefits.  

Though several states have made strides towards improved access to opioid addiction treatment and better, more comprehensive health care over the past year, improvements weren’t made across every state’s Medicaid plan. ASAM is committed to ensuring improvement continues by working with state and federal partners to improve patient access to vital, lifesaving opioid addiction therapies. Read the state reports online here: .