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J Subst Abuse Treat. 2015 Aug;55:1-5. doi: 10.1016/j.jsat.2015.04.009. Epub 2015 Apr 16.

Medicaid coverage of medications to treat alcohol and opioid dependence.

Author information

1
Truven Health Analytics, 7700 Old Georgetown Road, Bethesda, MA, 20814. Electronic address: tami.mark@truvenhealth.com.
2
Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD, 20857. Electronic address: robert.lubran@samhsa.hhs.gov.
3
Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD, 20857. Electronic address: elinore.mccance-katz@samhsa.hhs.gov.
4
Treatment Research Institute, 600 Public Ledger Building, 150S. Independence Mall West, Philadelphia, PA, 19106. Electronic address: mchalk@tresearch.org.
5
Truven Health Analytics, 7700 Old Georgetown Road, Bethesda, MA, 20814. Electronic address: jsrich@umich.edu.

Abstract

Substance use disorders affect 12% of Medicaid beneficiaries. The prescription drug epidemic and growing need for treatment of alcohol and opioid dependence have refocused states' attention on their provision of substance use disorder treatment services, including medications. This study characterized how Medicaid programs cover these treatment medications. Data were from 2013 Medicaid pharmacy documents, 2011 and 2012 Medicaid state drug utilization records, and a 2013 American Society of Addiction Medicine survey. Results showed that only 13 state Medicaid programs included all medications approved for alcohol and opioid dependence on their preferred drug lists. The most commonly excluded were extended-release naltrexone (19 programs), acamprosate (19 programs), and methadone (20 programs). For combined buprenorphine-naloxone, 48 Medicaid programs required prior authorization, and 11 programs used 1- to 3-year lifetime treatment limits. Given the chronic nature of substance use disorders and the overwhelming evidence supporting ongoing coverage for many of these medications, states may want to reexamine substance use disorder benefits.

KEYWORDS:

Alcohol; Financing health care; Insurance coverage; Lifetime treatment limits; Opioid; Preferred drug lists

PMID:
25921475
DOI:
10.1016/j.jsat.2015.04.009
[Indexed for MEDLINE]

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