Policy Points States contract with Medicaid managed care plans to administer benefits for roughly 70 million Medicaid enrollees, yet little is known about how plan benefit policies for substance use disorder (SUD) treatment medications align with state requirements. In this study, we found that among the population of 167 Medicaid managed care plans responsible for SUD pharmacy benefits in 2021, many did not align with state requirements to cover SUD treatment medications. Many plans imposed prior authorization requirements on these medications, even when prohibited from doing so. Alignment between state requirements and reported plan policies was less common among plans operating in Republican-leaning states.
Feltus SR, Andrews CM, Peterson L, Grogan CM, Abraham AJ, Hinds OM, Stewart MT. Medicaid Managed Care Plan Alignment With State Substance Use Disorder Treatment Coverage Requirements. Milbank Q. 2026 Apr 27. doi: 10.1111/1468-0009.70083. Epub ahead of print. PMID: 42037268.
