Access to Medication-Assisted Treatment
Access to medication-assisted treatment is challenging for some communities. These reasons include differences in what medications are covered under Medicaid and differences in how medications are accessed. These resources include a summary of a survey conducted by the American Society of Addiction Medication (ASAM) of State Medicaid agencies and information on how states have developed strategies to improve access.
Changes in Substance Abuse Treatment Use Among Individuals With Opioid Use Disorders in the United States, 2004-2013. Saloner and Karthikeyan, 2015. The study found that although individuals with opioid use disorders are receiving treatment in different types of settings, particularly in inpatient treatment at physician’s offices, treatment access and engagement continues to be low. https://jamanetwork.com/journals/jama/fullarticle/2456156
Medicaid coverage and use limitations differ from state to state, resulting in challenges in accessing Medicaid coverage in some areas. The American Society of Addiction Medication (ASAM), Advancing Access to Addiction Medications, conducted a survey of State Medicaid agencies on accessing Medicaid for MAT http://www.asam.org/docs/advocacy/implications-for-opioid-addiction-treatment. Challenges reported by states in accessing Medicaid for MAT include:
- Complex authorization and re-authorization processes
- Lengthy approval processes
- Minimal coverage or reimbursement of counseling services to accompany MAT while also requiring counseling services as a preauthorization requirement.
- "Fail first" or "Step therapy" criteria that require documentation that less costly therapies have proven ineffective
Substance Abuse and Mental Health Services Administration: Federal Guidelines for Opioid Treatment Programs. Provides updated guidelines for the operation of opioid treatment programs (OTPs). Covers patient assessment, treatment planning, medication-assisted treatment (methadone and buprenorphine), overdose and relapse prevention, and recovery care.
Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders. Presents information about Medicaid coverage of medication-assisted treatment for opioid and alcohol dependence. Covers treatment effectiveness and cost effectiveness as well as examples of innovative approaches in Vermont, Massachusetts, and Maryland. http://store.samhsa.gov/shin/content//SMA14-4854/SMA14-4854.pdf (PDF 1.5 MB)
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