Fewer Than Half of Medicaid Managed Care Plans Cover All Medications For AUD
Fewer than half of all Medicaid managed care plans (MCPs) covered all 4 US Food and Drug Administration (FDA)–approved medications for the treatment of alcohol use disorder (AUD), a cross-sectional study published in JAMA Network Open found.
“This study suggests that efforts to expand AUD medication prescribing may be limited by gaps in health insurance coverage,” wrote lead author Maureen T. Stewart, PhD, Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, and study coauthors.
READ>>Semaglutide Reduces Cravings in Adults with Alcohol Use Disorder
The study sought to investigate potential barriers to medication for AUD (MAUD) by conducting a content analysis of publicly available insurance benefit documentation for 241 Medicaid MCPs across 39 states and the District of Columbia in 2021. Researchers identified whether the 4 FDA-approved MAUD—acamprosate, disulfiram, and injectable and oral naltrexone—were included on each plan’s covered prescription drug list (PDL). The researchers also noted whether the plan included stipulations on prior authorization and quantity limit requirements.
The study found that while 217 (90.0%) of the MCPs covered at least 1 MAUD, only 103 MCPs (42.7%) covered all 4 medications. The results further showed that prior authorization and quantity limits were used for injectable naltrexone in 75 MCPs (42.8%) but were rarely used for oral naltrexone, disulfiram, and acamprosate.
MCPs that did not cover all 4 medications, researchers found, were somewhat concentrated in states with high populations of Black and Hispanic residents, residents living in rural areas, and residents with income below the federal poverty line, despite the fact that health consequences of excessive alcohol use, such as alcohol-related liver disease, cirrhosis of the liver, and alcohol-related mortality, are worse for these populations.
Authors noted a few limitations of the study, such as its use of publicly available insurance documentation and a lack of specificity in some plan description documents. The authors also note that no causality could be determined by the associations found in their analysis.
“More research is needed to understand why MCPs do not report covering these safe, effective, and relatively inexpensive medications. States and Medicaid MCPs should examine PDLs to ensure all MAUD are included and should continue limiting utilization management,” the authors concluded.
