{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T03:49:24Z","timestamp":1778125764856,"version":"3.51.4"},"reference-count":39,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T00:00:00Z","timestamp":1728518400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["P30DA035772"],"award-info":[{"award-number":["P30DA035772"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01DA049776"],"award-info":[{"award-number":["R01DA049776"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine whether Medicaid managed care plan (MCP) utilization management policies for buprenorphine\u2013naloxone and injectable naltrexone are related to key state Medicaid program policy decisions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources and Study Setting<\/jats:title><jats:p>We abstracted data on state Medicaid regulatory and policy information from publicly available sources and publicly available insurance benefit documentation from all 241 Medicaid MCPs operating in 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>In this cross\u2010sectional study, we used bivariate and multivariate analyses to examine whether Medicaid MCP prior authorization and quantity limits on receipt of buprenorphine and injectable naltrexone were associated with key state Medicaid choices to leverage federal funds to expand coverage and eligibility (Medicaid expansion, 1115 waivers) and to regulate Medicaid MCPs (uniform preferred drug lists, medical loss ratio remittance). Models were adjusted for MCP characteristics, including profit status, behavioral health contracting arrangement, National Committee for Quality Assurance accreditation, size, market share, and state opioid overdose death rates. Average marginal effects (AME) were reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Utilization management was common among MCPs, and restrictions were more commonly applied to buprenorphine than injectable naltrexone, despite its higher cost. States that required MCPs to comply with utilization management policies stipulated in a uniform preferred drug list were more likely to require prior authorization for buprenorphine (AME: 0.29, 95% CI: 0.15\u20130.42) and injectable naltrexone (AME: 0.25, 95% CI: 0.12\u20130.38). MCPs in states that required plans to pay back earnings above a certain threshold were less likely to require prior authorization for buprenorphine (AME: \u22120.30, 95% CI: \u22120.43 to \u22120.18).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Restrictions on medications for opioid use disorder are widespread among MCPs and vary by medication. State Medicaid regulatory and policy characteristics were strongly linked to MCPs' utilization management approaches. State Medicaid policy and contracting approaches may be levers to eliminate utilization management restrictions on medications for opioid use disorder.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.14394","type":"journal-article","created":{"date-parts":[[2024,10,11]],"date-time":"2024-10-11T01:28:57Z","timestamp":1728610137000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Medicaid managed care restrictions on medications for the treatment of opioid use disorder"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5470-0307","authenticated-orcid":false,"given":"Maureen T.","family":"Stewart","sequence":"first","affiliation":[{"name":"The Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina M.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Arnold School of Public Health University of South Carolina  Columbia South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sage R.","family":"Feltus","sequence":"additional","affiliation":[{"name":"The Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4494-9176","authenticated-orcid":false,"given":"Dominic","family":"Hodgkin","sequence":"additional","affiliation":[{"name":"The Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constance M.","family":"Horgan","sequence":"additional","affiliation":[{"name":"The Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cindy Parks","family":"Thomas","sequence":"additional","affiliation":[{"name":"The Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thuong","family":"Nong","sequence":"additional","affiliation":[{"name":"The Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,10,10]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Understanding the Opioid Overdose Epidemic","author":"Centers for Disease Control and Prevention","year":"2022"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.27488"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14991"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17\u20103107"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.15582"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab289"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.3821"},{"key":"e_1_2_8_9_1","volume-title":"A Look at Substance Use Disorders (SUD) Among Medicaid Enrollees","author":"Saunders H","year":"2023"},{"key":"e_1_2_8_10_1","volume-title":"10 Things to know about Medicaid Managed Care","author":"Hinton E","year":"2020"},{"key":"e_1_2_8_11_1","volume-title":"Program Enrollment and Spending: Medicaid Managed Care","author":"Medicaid and CHIP Payment and Access Commission","year":"2023"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.0189"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2018.304856"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2021.27.5.596"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.1757"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.6581"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.3132"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2014.07.035"},{"key":"e_1_2_8_19_1","volume-title":"Medicaid Coverage of Medication\u2010assisted Treatment for Alcohol and Opioid Use Disorders and of Medication for the Reversal of Opioid Overdose","author":"Substance Abuse and Mental Health Services Administration","year":"2018"},{"key":"e_1_2_8_20_1","unstructured":"Medical loss ratio (MLR) \u2010 Glossary. 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