Buprenorphine is an effective medication for the treatment of opioid use disorder (OUD). It promotes long-term recovery and decreases the risk of mortality. Buprenorphine treatment increases engagement in addiction treatment, reduces emergency department admissions, and is cost effective compared with brief intervention or referral treatments. A persistent barrier to buprenorphine access is prior authorization (PA)—a utilization management practice employed by insurers that requires healthcare providers to obtain approval from a health plan before a service is delivered to the patient in order to qualify for payment coverage.

This study analyzes how state Medicaid programs apply PA to buprenorphine products. As Medicaid is the dominant payer for behavioral health services in the U.S., an analysis of Medicaid PA requirements for buprenorphine products is essential to understanding how states use insurance policies to impact access to medications essential to the treatment of OUD.

The key findings demonstrate that although Medicaid programs largely cover buprenorphine products, many continue to apply PA requirements. Nearly 30% of PDLs reviewed do not cover a single buprenorphine form without PA, and almost 80% of PDLs do not cover a long-acting buprenorphine form without PA.

Amanda Mauri, MPH