Alcohol Use Disorder Medication Coverage and Utilization Management in Medicaid Managed Care Plans

Area of Science:

• Health Services Research
• Pharmacotherapy
• Addiction Medicine

Background:

• Evidence-based treatments for alcohol use disorder (AUD) include pharmacotherapy, yet these medications are underutilized.
• Medicaid managed care plans (MCPs) are major payers for addiction services, but their policies on AUD medications are not well understood.
• Understanding MCP coverage is crucial for improving access to AUD pharmacotherapy.

Purpose of the Study:

• To describe the coverage and utilization management of AUD medications (acamprosate, naltrexone, disulfiram) by Medicaid MCPs.
• To examine how plan characteristics and state policies influence medication coverage.
• To identify barriers to AUD medication access within Medicaid managed care.

Main Methods:

• Cross-sectional content analysis of 2021 insurance benefit data from 241 comprehensive Medicaid MCPs.
• Data included medication coverage and utilization management requirements (prior authorization, quantity limits).
• Analysis examined associations between plan characteristics (e.g., profit status) and state policies (e.g., waivers) and medication coverage.

Main Results:

• In 2021, 90% of Medicaid MCPs covered at least one AUD medication.
• Coverage varied by medication: acamprosate (54.7%), oral naltrexone (84.2%), injectable naltrexone (72.6%), and disulfiram (63.0%).
• Utilization management was uncommon, except for injectable naltrexone, which frequently had prior authorization or quantity limits.

Conclusions:

• Gaps in health insurance coverage may hinder the expansion of AUD medication prescribing.
• Medicaid MCPs and states can enhance AUD medication use by providing comprehensive coverage.
• Reducing utilization management strategies for AUD medications can improve patient access to evidence-based treatment.