Is access to a treatment of opiate dependence assured if the appropriate treatment medication is on a formulary?
No, it is not assured, but it helps those covered by the public medical plan such as Medicaid. A drug that is placed on a formulary may have limitations or restrictions such as prior authorization. Even if a medication is on a formulary, patients may have difficulty obtaining it if it is not on the highest tier. A payer such as Medicaid may limit the number of prescriptions that a patient may obtain during a given time or limit the length of time for which a particular medication may be reimbursed and/or require frequent reauthorizations. However, medications to treat substance dependence are most effective when taken in concert with counseling and recovery support services that also need to be available. Placing a medication for substance dependence treatment on a formulary is not sufficient to provide access to treatment if benefits such as physician visits, laboratory services and counseling are not covered and available. (NCSL and Avisa are surveying states about the Medicaid formu
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- Is access to a treatment of opiate dependence assured if the appropriate treatment medication is on a formulary?
