Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders

Approximately eight percent of individuals in the United States have a substance use disorder. Each year, an estimated 85,000 deaths are attributed to the use of alcohol and 17,000 deaths to the use of illicit drugs . Excessive alcohol consumption is associated with multiple adverse health and social consequences, including liver cirrhosis, certain cancers, fetal alcohol spectrum disorder, unintentional injuries, and violent behaviors . The use of illicit drugs has been linked to a variety of adverse health events, including HIV/AIDS, hepatitis and other infectious diseases, prenatal conditions, kidney and liver damage, stroke, and a number of respiratory, cardiovascular, and neurologic disorders. 

Fortunately, various effective options exist for treating these disorders, including a number of medications that have been approved by the U.S. Food and Drug Administration. These medications include disulfiram and acamprosate for treatment of alcohol dependence; methadone, buprenorphine, and buprenorphinenaloxone for treatment of opioid dependence; and naltrexone (oral and an injectable extended-release formulation) for treatment of alcohol or opioid dependence. 

This report describes (1) the treatment effectiveness and cost effectiveness of these medications, (2) their current coverage under each Medicaid program, and (3) examples of innovative financing and delivery models used by states to provide the medications to consumers.