Andrews CM, Feltus SR, Horgan CM, Thomas CP, Hodgkin D, Stewart MT. ( 2025) Coverage for Opioid Use Disorder Medications in Medicaid Managed Care. JAMA Health Forum, 6(9):e253239. PMCID: PMC12413645
Medications for opioid use disorder are lifesaving and Medicaid managed care plans play a critical role in facilitating access to opioid use disorder treatment. The 2018 federal SUPPORT Act required that all Medicaid managed care plans cover the three FDA-approved medications for opioid use disorder - buprenorphine, methadone, and naltrexone- for 5 years beginning October 1, 2020. Heller researchers and colleagues at Boston University and the University of South Carolina examined Medicaid managed care plan reported coverage for these medications. In 2023, 97% of Medicaid managed care plans, covering an estimated 37 million enrollees, reported covering buprenorphine and 46.6% of plans reported covering all three medications in publicly available drug formularies and member handbooks. The findings of this study reveal widespread gaps in publicly reported coverage of OUD medications in 2023, despite the federal SUPPORT Act requirement. The researchers recommend that Medicaid plans and state Medicaid programs review their materials to ensure coverage is reported accurately and complies with federal law.
Medicaid managed care plan (MCP) reported coverage of all three medications for OUD, 2023
Preliminary Results from a Nationwide Medicaid Managed Care Plan Survey. Medicaid managed care plans provide insurance for over three-quarters of Medicaid enrollees nationally and plan a critical role facilitating treatment for substance use disorders. This report presents preliminary findings from the first-ever national survey of Medicaid managed care plan policies related to substance use treatment.
Stewart MT, Feltus SR, Andrews CM, Acevedo A, Thomas CP, Bratberg J, Horgan CM, Hodgkin D, Adams RS. Alcohol Use Disorder Medication Coverage and Utilization Management in Medicaid Managed Care Plans. JAMA Netw Open. 2025;8(3):e250695.
Stewart MT, Andrews CM, Feltus SR, Hodgkin D, Horgan CM, Thomas CP, Nong T. (2024) Medicaid managed care restrictions on medications for the treatment of opioid use disorder. Health Services Research, 1-11.
Acevedo A, Adams RS, Cook BL, Feltus SR, Panas L, Stewart MT. Disparities in Alcohol Treatment Use at the Intersection of Race, Ethnicity, Gender, and Insurance. Substance Use & Addiction Journal. 2024;0(0).