State Medicaid programs are increasingly turning to medication-assisted treatment (MAT), which combines medication with counseling or behavioral therapies, to treat individuals with opioid and alcohol use disorders. States depend on utilization management to ensure appropriate care, control costs, and prevent drug diversion. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act, P.L. 115-271) directed MACPAC to examine state Medicaid utilization management policies that may affect access to MAT.
This Report to Congress: Utilization Management of Medication-Assisted Treatment in Medicaid responds to the SUPPORT Act directive. Based on analysis of available data on how MAT utilization management is used nationally, the report also draws on interviews with industry experts, clinicians, and state officials to examine how eight states—Arkansas, Illinois, Maine, Missouri, Tennessee, Utah, Washington, and West Virginia—apply preferred status, prior authorization, step therapy, prescription limits, quantity or dose limits, and lifetime limits to their Medicaid fee-for-service and managed care programs.