Medicaid Behavioral Health Services: Oral Buprenorphine for Medication Assisted Treatment (MAT)

2022

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 45; No - 0; NR - 6	Yes - 12	Yes - 13
Alabama	Yes	Yes - not specified	No
Alaska	Yes	NR	NR
Arizona	Yes	NR	No
Arkansas	NR	NR	NR
California	Yes	No	No
Colorado	Yes	$3	No
Connecticut	Yes	No	No
Delaware	NR	NR	NR
District of Columbia	Yes	No	Prior authorization is required when prescribed over the FDA approved maximum amount
Florida	Yes	No	Maximum of 3 sublingual film/tabs per day for Suboxone sublingual film, Zubsolv sublingual tablets, and Buprenorphine/naloxone tablets.
Georgia	NR	NR	NR
Hawaii	Yes	No	No
Idaho	Yes	No	No
Illinois	Yes	No	NR
Indiana	Yes	No	NR
Iowa	Yes	No	No
Kansas	Yes	No	No
Kentucky	Yes	No	NR
Louisiana	Yes	Yes - not specified	No
Maine	Yes	No	Yes - not specified
Maryland	Yes	$1 for generic and $3 for brand name, If the drug is administered as a part of a larger visit, there's no cost sharing	No
Massachusetts	Yes	Yes - not specified	No
Michigan	Yes	No	No
Minnesota	NR	NR	NR
Mississippi	Yes	$3 office based opioid treatment	Prior authorization is required when provided in an Opioid Treatment Program as a weekly bundled code including medication.
Missouri	Yes	Yes - not specified	No
Montana	Yes	No	Prior authorization is required
Nebraska	Yes	No	No
Nevada	Yes	No	Quantity limit
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	Yes	No	No
North Carolina	Yes	No	NR
North Dakota	Yes	No	No
Ohio	Yes	No	Yes - not specified
Oklahoma	Yes	No	NR
Oregon	Yes	No	No
Pennsylvania	Yes	$1 for generic prescriptions, $3 for brand-name	Prior authorization is required in limited situations
Rhode Island	Yes	No	No
South Carolina	Yes	No	NR
South Dakota	Yes	$1 pharmacy copay for generic and $3.30 for brand-name	No
Tennessee	Yes	No	No
Texas	Yes	No	If provided in an outpatient setting, limit of once per date of service by any provider; for take-home doses, limit of a quantity of 30 per 30 days by any provider; also available as a pharmacy benefit where standard quantity limits apply
Utah	NR	NR	NR
Vermont	Yes	$1, $2 or $3, depending on the cost of the drug	Prior authorization is required for doses over 16 mg per day
Virginia	Yes	No	No
Washington	Yes	No	No
West Virginia	Yes	No	Based on medical necessity
Wisconsin	Yes	$1 generic, $3 brand for drugs billed under the pharmacy benefit	Member is required to meet clinical criteria for opioid dependency
Wyoming	Yes	$0.65 generic, $3.65 brand	More than 16 mg buprenorphine per day requires a prior authorization

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Medicaid Behavioral Health Services: Oral Buprenorphine for Medication Assisted Treatment (MAT)

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Medicaid Behavioral Health Services: Oral Buprenorphine for Medication Assisted Treatment (MAT)

2022

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