Although Medicaid is one of the largest sources of coverage for individuals receiving medication-assisted treatment (MAT), an evidence-based best practice for treating opioid use disorder (OUD), there remain some roadblocks for patients to access the life-saving treatment. The Government Accountability Office (GAO) released a report last week highlighting state and federal policy barriers for Medicaid enrollees to access MAT. GAO also included recommendations that the Department of Health and Human Services (HHS) ensure that states comply with federal requirements to cover MAT medications.
As required in the SUPPORT Act, GAO examined policies surrounding MAT medications including buprenorphine, buprenorphine-naloxone, and naltrexone, and three selected states’ and the District of Columbia’s efforts to address potential access barriers. The report outlines these barriers including the following:
- Federal Waiver for Prescribing Buprenorphine: According to stakeholders interviewed by GAO, some providers are unwilling to go through the process to obtain a federal waiver necessary to prescribe or administer buprenorphine for OUD, which can restrict beneficiary access to the drug. Additionally, while nurse practitioners and physician assistants are eligible for these waivers, some state laws require them to be supervised by a physician, further restricting access to MAT. The National Council supports legislation that would remove this federal waiver requirement, which would expand access to MAT for millions of Americans living with addiction.
- MAT Medication Coverage: A 2018 study found that 40 percent of states may not provide Medicaid coverage for some forms of MAT medications as required by federal law; however the Centers for Medicare and Medicaid Services (CMS) has not ensured compliance with these laws by determining the extent to which states are covering MAT medications.
- Prior Authorization Requirements: Some MAT medications are subject to prior authorization, and stakeholders told GAO that these requirements may cause life-threatening delays in treatment initiation. Some states have taken steps to remove these prior authorization requirements via Medicaid waivers.
- Distribution Methods: States may determine MAT medication distribution methods, and though some methods may allow for more immediate access to MAT, they could put providers in financial risk. In response, some states have removed restrictions on distribution methods to maximize beneficiary access and lower risk for providers.