(D) State-By-State Analysis of Medicaid Barriers to Medication for Opioid Use Disorder (MOUD) Access

Sunday, August 28, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 1003

Presenting Author(s)

Sophia L. Balkovski
– University of California, Los Angeles

Co-Author(s)

Catherine Psaras
– University of California, Los Angeles, University of California, Los Angeles, Los Angeles, California, United States
Marissa Seamans, PhD MSPH
– Assistant Professor, UCLA Fielding School of Public Health, United States

Background: Medicaid was significantly expanded in 2014 through the Affordable Care Act (ACA), affecting barriers to access for medication for opioid use disorder (MOUD).

Objectives: The objective of this study was to examine barriers to MOUD state-by-state within Medicaid’s managed care (MC) and fee-for-service (FFS) plans in 2014.

Methods: Medicaid documentation related to MOUD was collected for all states. Three medication categories were examined: (1) Methadone, (2) Buprenorphine (4 drug brand-name and generic variations) and (3) injectable naltrexone. Medicaid coverage requirements analyzed included: counseling required, step therapy, prior authorization, pharmacy/medical benefits, treatment programs covered, preferred drug list (PDL) status for generic/brand-name, dosage/age limits, as well as rules for pregnancy. Income requirements to qualify for Medicaid were also considered. The results were entered into a dataset and commonalities and differences were identified and analyzed.

Results: Prior authorization was required for 39 states while proof of substance use disorder counseling was needed for 46 states. Dosage limits, especially for buprenorphine-based medications, were required for virtually every state, ranging from 8-32mg/day, with many having 2-year limits.
Most states that had age limits required patients to be at least 16 years old to start MOUD. PDL status for each state was very different, with an even mix of states preferring generic over brand-name and the reverse.
Many states did not have naltrexone on their PDL at all, likely due to its high cost.
Buprenorphine was the most commonly approved medication during pregnancy, when mentioned, though many states did not have data on the subject.
The income required to enter Medicaid depended on whether states adopted ACA reforms.

Conclusions: Significant barriers to access to MOUD involved dosage limits, proof of counseling/prior authorization, as well as PDL status. These barriers could have significant outcomes for Medicaid holders with OUD and thus need to be further studied. Further work would expand analysis to 2016 and 2019 years.