Commercial insurance and Medicaid coverage policies play a crucial role in determining the degree to which patients can access medications for opioid use disorder (MOUD) treatment. MOUD treatment is an evidence-based strategy that uses a combination of counseling, behavioral health therapy, and three medications approved by the FDA (buprenorphine, methadone, and naltrexone) to effectively treat opioid use disorder.
Coverage requirement provisions can work to ensure patient access to MOUD, whereas coverage limitations can create barriers MOUD access. While federal laws and regulations have implications for the coverage of MAT, state statutes and regulations that vary from state to state also affect a person’s ability to access MOUD. State-level commercial insurance policies and state-specific Medicaid coverage laws can dictate the specific types of medications that can be covered, and may also include limits on prescription refills, requirements for prior authorization, quantity limits, age limitations, and “fail first” requirements, among others.
This dataset, which is published to the Prescription Drug Abuse Policy System (PDAPS.org) is longitudinal and displays key features of state commercial insurance and Medicaid coverage laws related to MOUD across all 50 states and the District of Columbia, in effect between August 1, 2017 and August 1, 2020.