Medication-Assisted Treatment Use Up Among Medicaid Beneficiaries — But Roadblocks Remain

The number of Medicaid beneficiaries receiving medication-assisted treatment (MAT) to fight opioid use-disorder (OUD) is growing — but significant barriers to access remain.

Between 2013 to 2017, the number of Medicaid prescriptions for MAT medications boomed, tripling for one drug — buprenorphine — and quadrupling for another — naltrexone. Despite the spike, 56% of beneficiaries with OUDs still aren’t receiving any substance abuse treatment at all.

That’s according to an October report from the Medicaid and CHIP Payment and Access Commission (MACPAC), a non-partisan agency that advises Congress on issues related to Medicaid and the Children’s Health Insurance Program (CHIP).

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MAT is the use of medication, counseling and behavioral therapies to treat alcohol and opioid addiction. For opioid treatment, three different drugs can be prescribed to achieve various results.

For example, buprenorphine somewhat diminishes withdrawal symptoms, while naltrexone prevents the brain from responding to opioids. Meanwhile, the third drug, methadone, is used to provide stronger relief for withdrawal symptoms — and even get rid of opiate cravings.

When used correctly, MAT has proven to keep people in OUD treatment and reduce relapses, while also lessening the risk of criminal activity, infectious disease transmission and overdose deaths among participants, studies have shown.

But utilization is relatively low among Medicaid beneficiaries with OUD.

MACPAC’s report looks at potential reasons why, specifically identifying barriers to MAT access on a state-by-state level and examining whether utilization management policies play a role in hindering Medicaid beneficiaries’ access to MAT.

Utilization management policies are rules set by states to ensure appropriate care for patients while preventing fraud and abuse.

For example, a state might have certain prior authorization requirements that need to be met before beneficiaries can receive MAT, such as drug testing or evidence that the patient is also receiving psychosocial treatment with their medications. States might also impose dosage limits or a lifetime limit on coverage of MAT.

However, it’s not clear how such policies affect MAT access, according to the report.

“Overall, we found that utilization management policies vary widely among states, but the extent to which these policies pose barriers to MAT access is unclear,” MACPAC Chair Melanie Bella wrote in the commission’s letter to Congress. “For example, some states have removed medications used in MAT from preferred drug lists, which may make it more difficult for patients with Medicaid to gain access to these drugs. At the same time, we found a trend toward reduced use of prior authorization, which would ease an important barrier to access.”

The authors noted a number of additional factors could also be to blame for the low participation in substance abuse treatment by Medicaid beneficiaries with OUDs.

“These obstacles include stigma, low provider payment rates, lack of provider training, insufficient availability of providers with relevant training and capacity across geographic areas, restrictive state scope-of-practice laws, and preferences among some providers and patients for abstinence-based approaches to SUD treatment,” they wrote.