Coverage and Prior Authorization Policies for Medications for Opioid Use Disorder in Medicaid Managed Care

In this cross-sectional study of 266 Medicaid MCO plans and 39 FFS programs, FFS programs offered more generous MOUD coverage, but a higher percentage of FFS programs imposed PA than MCO plans. Although most Medicaid MCO and FFS beneficiaries were enrolled in a plan that covered MOUD, approximately 50% were subject to PA. Despite concerns that PA policies are a barrier to MOUD access, these policies remain widespread in the nation’s Medicaid programs. 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.