MACPAC is continuing its work to examine access to MOUD for Medicaid enrollees. MACPAC’s work in this area explores whether utilization management strategies allow states and managed care plans to control costs and prevent misuse while maintaining appropriate and timely access to MOUD. Specifically, we focus on three utilization management strategies commonly applied to MOUD: prior authorization, daily dosage limits, and refill thresholds.
In this session, staff provided background information on the types of MOUD and utilization management strategies examined in our study, followed by takeaways from a literature review examining federal, state, and managed care organization (MCO) policies; clinical guidelines; peer-reviewed and gray literature; and stakeholder interviews. MACPAC conducted 17 stakeholder interviews with state and federal officials, MCOs, provider and pharmacy associations, a patient advocacy group, and an individual with lived experience.