@article{TEXTUAL,
      recid = {11293},
      author = {Abraham, Amanda J. and Andrews, Christina M. and Harris,  Samantha J. and Westlake, Melissa M. and Grogan, Colleen  M.},
      title = {Coverage and Prior Authorization Policies for Medications  for Opioid Use Disorder in Medicaid Managed Care},
      journal = {JAMA Health Forum},
      address = {2022-11-04},
      number = {TEXTUAL},
      abstract = {<p>Importance: Medicaid is a key policy lever to improve  opioid use disorder treatment, covering approximately 40%  of Americans with opioid use disorder. Although  approximately 70% of Medicaid beneficiaries are enrolled in  comprehensive managed care organization (MCO) plans, little  is known about coverage and prior authorization (PA)  policies for medications for opioid use disorder (MOUD) in  these plans.</p> <p>Objective: To compare coverage and PA  policies for buprenorphine, methadone, and injectable  naltrexone across Medicaid MCO plans and fee-for-service  (FFS) programs and across states.</p> <p>Design, Setting,  and Participants: This cross-sectional study analyzed MOUD  data from 266 Medicaid MCO plans and FFS programs in 38  states and the District of Columbia in 2018.</p> <p>Main  Outcomes and Measures: For each medication, the percentages  of MCO plans and FFS programs that covered the medication  without PA, covered the medication with PA, and did not  cover the medication were calculated, as were the  percentages of MCO, FFS, and all (MCO and FFS)  beneficiaries who were covered with no PA, covered with PA,  and not covered. In addition, MCO plan coverage and PA  policies were mapped by state. Analyses were conducted from  January 1 through May 31, 2022.</p> <p>Results: Coverage  and PA policies were compared for MOUD in 266 MCO plans and  39 FFS programs, representing approximately 70 million  Medicaid beneficiaries. Overall, FFS programs had more  generous MOUD coverage than MCO plans. However, a higher  percentage of FFS programs imposed PA for the 3 medications  (47.0%) than did MCOs (35.9%). Furthermore, although most  Medicaid beneficiaries were enrolled in a plan that covered  MOUD, 53.2% of all MCO- and FFS-enrolled beneficiaries were  subject to PA. Results also showed wide state variation in  MCO plan coverage and PA policies for MOUD and the  percentage of Medicaid beneficiaries subject to PA.</p>  <p>Conclusions and Relevance: This cross-sectional study  found variation in MOUD coverage and PA policies across  Medicaid MCO plans and FFS programs and across states.  Thus, Medicaid beneficiaries’ access to MOUD may be heavily  influenced by their state of residency and the Medicaid  plan in which they are enrolled. Left unaddressed, PA  policies are likely to remain a barrier to MOUD access in  the nation’s Medicaid programs.</p>},
      url = {http://knowledge.uchicago.edu/record/11293},
}