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

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2022

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 44; No - 1; NR - 6	Yes - 13	Yes - 4
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	No
Florida	Yes	No	No
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	No
Nebraska	Yes	No	No
Nevada	Yes	No	No
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	Yes	No	No
North Carolina	Yes	$4	NR
North Dakota	Yes	No	No
Ohio	Yes	No	No
Oklahoma	Yes	No	NR
Oregon	Yes	No	No
Pennsylvania	Yes	$1 for generic prescriptions, $3 for brand-name	No
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	Yes, Not Specified
Utah	NR	NR	NR
Vermont	Yes	$1, $2 or $3, depending on the cost of the drug	No
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	NR
Wyoming	Yes	$0.65 generic, $3.65 brand	No

2018

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 51 No - 0 NR - 0	Yes - 21	Yes - 14
Alabama	Yes	$0-3.90 dependent on drug cost	Prior Authorization
Alaska	Yes	NR	NR
Arizona	Yes	$2.30 per prescription for beneficiaries with Transitional Medical Assistance	No
Arkansas	Yes	NR	NR
California	Yes	No	No
Colorado	Yes	Yes - Not Specified	No
Connecticut	Yes	No	Prior Authorization required
Delaware	Yes	No	Prior approval, medically necessary by physician with waiver to prescribe buprenorphine
District of Columbia	Yes	$1.00/Rx for point of sale drugs only	No
Florida	Yes	No	No
Georgia	Yes	$.50 to $3.00	No
Hawaii	Yes	No	No
Idaho	Yes	No	NR
Illinois	Yes	NR	NR
Indiana	Yes	$3 per prescription	Yes - Not Specified
Iowa	Yes	NR	NR
Kansas	Yes	No	No
Kentucky	Yes	Generic prescription drug $1 Preferred brand name drug $4	No
Louisiana	Yes	$0.50-$3.00 based on drug cost	No
Maine	Yes	$3/Rx, up to $30/month	24 months/lifetime unless additional hours prior approved
Maryland	Yes	$1 for generic and preferred brand name drugs; $3 for other brand name drugs	Services are pre-authorized
Massachusetts	Yes	No	No
Michigan	Yes	No	No
Minnesota	Yes	No	NR
Mississippi	Yes	$3 Copay (excludes EPSDT, LTC and pregnant women)	2 Brand/5 prescription per month limit
Missouri	Yes	$0.50 - $2 based on ingredient cost	No
Montana	Yes	No	No
Nebraska	Yes	No	No
Nevada	Yes	No	No
New Hampshire	Yes	zero, $1.00 and $2.00 dependent upon multiple factors: FPL, drug, if waiver recipient and preferred drug status	No
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	Yes	NR	NR
North Carolina	Yes	No	NR
North Dakota	Yes	$3 per prescription fill for brand names only	No
Ohio	Yes	No	Any qualified prescriber may prescribe or dispense oral naltrexone as a part of SUD treatment.
Oklahoma	Yes	6 per month limit, up to 2 brand-name; $4 copay for each prescription.	Scope and utilization controls.
Oregon	Yes	No	No
Pennsylvania	Yes	No	Medical necessity
Rhode Island	Yes	No	No
South Carolina	Yes	NR	NR
South Dakota	Yes	NR	NR
Tennessee	Yes	$3 for brand name drugs; $1.50 for generic drugs	NR
Texas	Yes	No	No
Utah	Yes	$4 for each prescription	Quantity limits, PA required for above FDA dose
Vermont	Yes	$1-3 depending on cost	No
Virginia	Yes	No	No
Washington	Yes	No	Age limitation, client must be 18 years or older.
West Virginia	Yes	Copays based on cost of the drug for adults: $0-$5.00=$0.00; $5.01-$10.00=$0.50; $10.01-$20.00=$1.00; $20.01-$50.00=$2.00; $50.01 and greater=$3.00. Out of Pocket Maximums Apply and are combined with medical copayment amounts: Tier 1 (up to 50% FPL)-$8.00; Tier 2-(50.01-100%FPL)-$71.00; Tier 3-(100.01% and above)-$143.00	No
Wisconsin	Yes	Generic status of uncompounded products: $1.00, Brand status: $3.00, Maximum copayment of $12.00 per member, per provider, per calendar month.	Restricted by diagnosis.
Wyoming	Yes	Client copay is $0.65 per prescription for generic drugs and $3.65 per prescription	Limited to clients with diagnosis of alcohol or opioid dependence

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

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

2022

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