LAC Analysis of Medicaid Plans Reveals 40 States Still Require Prior Authorization on OUD Meds

Report highlights findings and recommends Medicaid adopt Medicare model

As the opioid-related overdose epidemic continues to escalate in our country, timely access to FDA-approved medications for the treatment of opioid use disorder (OUD) is more important than ever. An analysis by the Legal Action Center shows that 40 state Medicaid programs still have prior authorization requirements on some or all buprenorphine-naloxone medications covered on their preferred drug list. As Medicaid provides health coverage for 40% of non-elderly adults with OUD, expanding access to these life-saving medications is critical.

The report, authored by LAC’s Vice President of Health Initiatives, Ellen Weber, and LAC’s 2019 Liman Fellow, Arka Gupta, builds upon SAMHSA’s 2018 report and details the gaps in coverage and prior authorization barriers to buprenorphine medications in all state Medicaid programs. The report also highlights new research from RTI International that examines how Medicare plans have eliminated such barriers based on guidance from the Centers for Medicare and Medicaid Services (CMS) and serves as a model for Medicaid to follow.

With an estimated 130 Americans losing their lives each day to opioid-related overdose, it is absolutely crucial that we break down barriers to OUD medications, which have been proven to cut a patient’s risk of death in half. “Clear guidance from CMS could immediately and significantly reduce barriers in the Medicaid program,” says Ellen. “The imperative to increase access to care is clear and pressing.”

You can learn more by reading this Modern Healthcare article covering the findings.

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