Obstacles and Advances to Accessing Medication for Opioid Use Disorder
By Marissa Schwartz
Medication for Opioid Use Disorder (MOUD), sometimes referred to as Medication-Assisted Treatment (MAT), is a life-saving, evidence-based treatment method considered the gold standard for addressing opioid use disorders. Unfortunately, however, there are a number of barriers — both legal and cultural — that prevent some patients from accessing the treatment they need.
MOUD combines the use of prescription medications (like buprenorphine, methadone, and naltrexone) with counseling and behavioral therapies to provide comprehensive treatment in an inpatient or outpatient setting.
Due to stigma toward MOUD from patients and providers, as well as an overall lack of providers certified to dispense MOUD, there are currently more prescribing rules in the U.S. for the drugs used in MOUD, like buprenorphine, than for opioids. Major legal barriers include provider limits on the number of patients to whom they can offer MOUD, restrictions on which facilities can provide in-patient MOUD treatment, and insurance pre-authorization requirements.
Some state legislatures and leaders have begun to take measures into their own hands, working with insurance companies to remove prior authorization requirements for MOUD. So far, 21 states have enacted laws to prevent insurance companies from requiring prior authorizations that impede patients’ ability to get the drugs they are prescribed.
In addition to obstacles posed by private insurance companies, state Medicaid coverage can also limit access to MOUD. Though buprenorphine is covered by Medicaid in all 50 states and Washington, D.C., according to a PDAPS dataset, many hurdles remain before a patient can actually access the treatment they need.
Medicaid recipients face opioid use disorders at higher rates than individuals with private insurance, but on top of stigma and other barriers to MOUD, Medicaid recipients are limited in which healthcare providers will accept their insurance. Research shows that providers of medication-assisted treatment are more likely to accept individuals with private insurance than Medicaid.
And for rural populations, there simply might be a lack of providers who can offer MOUD, due to the required federal certification. Changes to federal law, like the SUPPORT Act in 2018, expanded buprenorphine prescribing privileges to additional medical professionals including Clinical Nurse Specialists, increasing the likelihood for patients to access treatment. Both state and federal legislation, therefore, can make it easier for people with opioid use disorders to get the services they need.
In 2019, New Jersey Governor Phil Murphy and other state officials launched plans to expand access to MOUD by supporting provider and patient costs that accompany MOUD. Funding will increase provider training, subsidize Medicaid costs, and support other programs that patients may need, like housing and employment. Over the past year, state officials also have worked to expand MOUD to incarcerated individuals in the state’s prisons, which has been highly effective at treating opioid use disorder among the incarcerated population.
In New Jersey, the approach to addressing opioid use disorder is data-driven and focused on removing barriers to treatment. This may be a useful model as states continue to grapple with improving access to treatment. New Jersey is an example of state leaders eliminating barriers on the supply and demand sides, both through incentivizing healthcare professionals to become certified providers, expanding funding so that more patients can afford the treatment, and providing other wraparound services to support the success of patients’ treatment.
Marissa Schwartz is a JD Candidate at the University of Pennsylvania Carey Law School, and a 2020 CPHLR summer intern.
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