Medicaid limitations affect availability of opioid addiction meds, especially in South, Great Plains

Rate of buprenorphine prescriptions paid
by Medicaid by state (Pew graphic)

Medicaid limitations in some states make it difficult to treat opioid addiction, Christine Vestal reports for Stateline.

While all states reimburse for buprenorphine—the most widely used opioid addiction medication—"the fees Medicaid pays doctors are considered too low and the paperwork too time-consuming to attract an adequate number of providers willing to treat Medicaid enrollees with addictions," Vestal writes.

"In addition, coverage provisions such as prior authorizations, dosage and duration limits, requirements that patients 'fail first' at cheaper treatments that do not include medication, high copays and excessive counseling requirements make it difficult for Medicaid enrollees to get effective treatment for the chronic, lifelong disease of addiction," Vestal writes.

Many of the state's where Medicaid pays for the lowest share of buprenorphine are in the South and Great Plains, led by Mississippi, where the state's program only pays for four percent of prescriptions, Vestal writes. "Alabama, Arkansas, Florida, Georgia, Kansas, Louisiana, Montana, Nebraska, Tennessee, Texas, Oklahoma and Utah each pay for 10 percent or less of buprenorphine prescriptions."

From July 1, 2015 to June 30 of this year U.S. pharmacies dispensed 12.5 million prescriptions for buprenorphine, a 6.4 percent increase over the previous year, Vestal writes. "Commercial insurers paid for 57 percent of prescriptions, Medicare paid for 7 percent, and patients paid out-of-pocket for 11 percent of all retail sales."