Differences in OUD Treatment Coverage Across Medicaid Managed Care Plans From 2015 to 2019
Key Takeaways:
- From 2015 to 2019, the number of Medicaid managed care plans (MMCO) covering opioid use disorder (OUD) medications increased. Plans covering all 3 US Food and Drug Administration (FDA)-approved OUD medications (methadone, buprenorphine, and injectable naltrexone) increased from 18.2% to 42.1%.
- Coverage of OUD treatment services decreased from 2015 to 2019. MMCO plans covering inpatient treatment, detoxification, residential care, and peer support services decreased 22.7% to 7.9%.
- MMCO plans requiring prior authorization for OUD medications decreased from 2015 to 2019, but quantity limit requirements increased.
Medicaid is the largest payer of addiction treatment in the US, and most of Medicaid’s beneficiaries are enrolled in an MMCO plan. However, treatment benefits for OUD vary across MMCO plans, and little research has been done to assess changes in coverage over time.
To examine gaps in OUD coverage, a study examined changes in coverage for OUD services and medications among MMCO plans from 2015 to 2019. Data was gathered from 760 MMCO plans across 38 states and the District of Columbia.
Changes in OUD Treatment Coverage
Coverage for OUD medications significantly increased from 2015 to 2019, with the exception of methadone. The proportion of plans covering methadone was 50.57% in 2015 and 47.9% in 2019. Plans covering all 3 FDA-approved OUD medications (methadone, buprenorphine, and injectable naltrexone) increased from 18.2% in 2015 to 42.1% in 2019.
While Medicaid expanded access for OUD medications, OUD treatment services did not receive the same increase in coverage. In fact, the number of plans covering these services decreased over time. Plans covering inpatient treatment decreased from 76.1% in 2015 to 62.9% in 2019, and detoxification coverage decreased from 58.0% to 38.6%. However, plans covering residential treatment and peer support services increased during the time frame. Plans covering all treatment services decreased from 22.7% in 2015 to 7.9% in 2019, and only 4% of plans covered the full continuum of substance use disorder (SUD) care.
Prior authorization requirements for most OUD medications decreased from 2015 to 2019. Methadone is once again an exception to this trend, as prior authorization requirements increased from 17.6% in 2015 to 34.6% in 2019. However, quantity limit requirements appear to be replacing prior authorization, as plans requiring quantity limits increased between 2015 and 2019.
Coverage Affects Patient Access
Prior research has demonstrated that access to OUD medications and treatment services improves patient outcomes and reduces the risk of overdose. Expanding access to SUD treatments can help treat patients with addition. Although access to OUD medications has increased, coverage of treatment services has decreased, barring patients from receiving comprehensive treatment.
The study’s authors said, “Future policy is needed to address remaining gaps in MMCO treatment coverage across the full continuum of care as the United States remains amid an opioid epidemic.”
Reference
Hinds OM, Westlake MA, Patel S, et al. Trends in Medicaid managed care benefits for opioid use disorder treatment, 2015–2019. J Subst Use Addict Treatment. 2026;189:210014. doi:10.1016/j.josat.2026.210014
