Medicaid Behavioral Health Services: Suboxone Treatment

2022

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 43; No - 2; NR - 6	Yes - 12	Yes - 12
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	Subject to automated prior authorization
Georgia	NR	NR	NR
Hawaii	Yes	No	No
Idaho	Yes	No	No
Illinois	Yes	No	NR
Indiana	Yes	No	NR
Iowa	No
Kansas	Yes	No	No
Kentucky	Yes	NR	NR
Louisiana	Yes	Yes - not specified	Yes - not specified
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	Non-preferred agent; quantity limits
New Hampshire	NR	NR	NR
New Jersey	Yes	No	No
New Mexico	No
New York	Yes	No	No
North Carolina	Yes	$4	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	Available as a pharmacy benefit where standard quantity limits apply
Utah	NR	NR	NR
Vermont	Yes	NR	NR
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	More than 16 mg buprenorphine per day requires a prior authorization

2018

Location	Service Covered?	Copayment Required?	Limits on Services?
United States	Yes - 44 No - 2 NR - 5	Yes - 19	Yes - 19
Alabama	Yes	$0-3.90 dependent on drug cost	Prior Authorization
Alaska	No
Arizona	Yes	No	No
Arkansas	NR	NR	NR
California	No
Colorado	Yes	No	No
Connecticut	Yes	No	Film/Sublingual
Delaware	Yes	No	In accordance with ASAM and State guidelines
District of Columbia	Yes	$1.00/Rx for point of sale drugs only	No
Florida	Yes	No	Please see footnote for more information on limits
Georgia	Yes	$.50 to $3.00	No
Hawaii	Yes	No	No
Idaho	Yes	No	NR
Illinois	NR	NR	NR
Indiana	Yes	$3 per prescription	Dose, quantity, age limits apply.
Iowa	NR	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	24mg/day for 90 days then 16mg/day with no duration. Dose based on buprenorphine component
Maine	Yes	$.50 to $2/day depending on payment amount, up to $20/month	Med management limits apply: 1 hour for assessment, then 30 minutes/day
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)	Please see footnote for more information on limits
Missouri	Yes	$0.50 - $2 based on ingredient cost	No
Montana	Yes	$4 per date of service	No
Nebraska	Yes	No	No
Nevada	Yes	No	No
New Hampshire	Yes	No	Prior authorization requrement for the drug itself (see line 36), not on the service.
New Jersey	Yes	No	No
New Mexico	Yes	No	No
New York	NR	NR	NR
North Carolina	Yes	No	NR
North Dakota	Yes	$3 per prescription fill for brand names only	No
Ohio	Yes	No	Suboxone Prescriptions written by prescribers not licensed by Ohio Department of Mental Health and Addiction Services are subject to clinical authorization after the first 7 days of therapy to determine medical necessity. The initial authorization cannot exceed 30 days, subsequent authorizations may be up to 6 months. Patients must receive other SUD treatment services in addition to MAT.
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	NR	NR	NR
South Dakota	Yes	NR	NR
Tennessee	Yes	$3 for brand name drugs; $1.50 for generic drugs	NR
Texas	Yes	No	Available at an opioid treatment program or as a pharmacy benefit where standard quantity limits apply
Utah	Yes	$4 for each prescription	Quantity limits, PA after initial 180 days
Vermont	Yes	$1-3 depending on cost	NALOXONE HCL Prefilled luer-lock needleless syringe plus intranasal mucosal atomizing device (Rescue kit) NARCAN® (naloxone hcl) Nasal Spray Quantity Limit = 4 single-use sprays/28days
Virginia	Yes	No	No
Washington	Yes	No	Limited to 32mg/day, client must be over age 16.
West Virginia	Yes	See above-applies when prescribed for outpatient use	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 •Not covered for SeniorCare members over 200% FPL
Wyoming	Yes	Client copay is $0.65 per prescription for generic drugs and $3.65 per prescription	Treatment doses covered for first two years of treatment; maintenance doses of 8mg/day or less covered after 2 years; all buprenorphine coverage requires PA

Topics

Policy Research

Polling

Health News

Data & Features

For Media

About

Medicaid Behavioral Health Services: Suboxone Treatment

Data are loading

Medicaid Behavioral Health Services: Suboxone Treatment

2022

2018

Topics

Categories