According to the Substance Abuse and Mental Health Services Administration (SAMHSA), medication-assisted treatment (MAT), which is provided in opioid treatment programs, combines behavioral therapy and medications to treat substance use disorders. MAT is the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Some states are exploring changes to scope of practice policies to enable greater access to MAT, including the use of buprenorphine-containing products.
Buprenorphine is used as part of MAT for opioid addiction and treats opioid dependence and addiction by diminishing withdrawal symptoms and cravings. Federal laws and regulations provide a framework for medication-assisted treatment on which states may build and implement additional laws and regulations. Prior to January 2023, federal law required practitioners to apply for a special waiver prior to prescribing buprenorphine for the treatment of opioid use disorder (OUD). This requirement has since been lifted and all practitioners who hold a current DEA registration (that includes schedule III authority) can prescribe buprenorphine for OUD.
Prior authorization is defined by the U.S. Centers for Medicare & Medicaid services as “approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan.” Some state Medicaid programs and/or private insurance companies require providers to seek prior authorization before prescribing buprenorphine or other MAT. Other states explicitly prohibit or limit the use of prior authorization by state Medicaid programs and/or private insurance companies, which could reduce barriers to the medications by making it easier for clinicians to prescribe.
The map below shows which states prohibit or limit the use of prior authorization for buprenorphine-containing products as well as those states that leave it up to the discretion of the state Medicaid program and private insurance companies (or "private insurers").