Proportion of Complete Medicaid Managed Care Plans (MCPs) Masking All Medicines for Alcohol Use Dysfunction by State, 2021. Credit score: JAMA Community Open (2025). DOI: 10.1001/jamanetworkopen.2025.0695
As well being problems and deaths from alcohol use dysfunction (AUD) enhance in the US, it’s essential that individuals who may gain advantage from drugs have entry to the medicine that the US Meals and Drug Administration has authorized to deal with AUD. But, for people who’ve alcohol use dysfunction and are coated by Medicaid, accessing these drugs is tough; previous analysis signifies that solely about 1 in 20 Medicaid enrollees with alcohol use dysfunction obtain these medicine.
Now, a brand new examine led by Boston College College of Public Well being (BUSPH) means that restricted insurance coverage protection could also be a potential barrier to those drugs for people who’ve Medicaid managed care plans (MCP)—which is sort of 80% of all Medicaid enrollees.
Revealed in JAMA Community Open, the examine discovered that lower than half of Medicaid plans cowl all 4 of the FDA-approved drugs, which embody acamprosate, disulfiram, and oral and injectable naltrexone. Whereas 90% of Medicaid MCPs cowl not less than one of many AUD drugs, solely 43% cowl all 4 choices. The vast majority of these plans coated naltrexone—84% coated the oral model and 73% coated the injectable model—whereas 63% of MCPs coated disulfiram and 55% coated acamprosate.
“Medications for AUD can help people drink less, reduce cravings, and are associated with reduction in alcohol-related liver disease, but we see that over half of Medicaid managed care plans are not providing the full range of coverage for these potentially life-saving medications,” says examine lead and corresponding writer Dr. Maureen Stewart, analysis affiliate professor of well being regulation, coverage & administration at BUSPH.
“People with alcohol use disorder need access to all four of the FDA-approved medications to accommodate variation in preferences due to potential side effects of the medications, and because different people may respond best to a specific medication.”
The staff hopes that Medicaid managed care plans increase their checklist of coated drugs to incorporate the entire FDA-approved AUD drugs. “State Medicaid programs contract with plans and can encourage plans to update their formularies,” Dr. Stewart says, including that together with all AUD drugs on formularies wouldn’t solely facilitate entry for sufferers, but in addition cut back administrative burdens for suppliers. “Three of the four medications are available in generic form and therefore are not expensive, so costs should not be a burden.”
The examine aimed to fill a information hole on Medicaid MCP insurance policies relating to AUD drugs. Researchers from BUSPH, the Heller College for Social Coverage and Administration at Brandeis College, the College of South Carolina Arnold College of Public Well being, and Booz Allen Hamilton, Inc. examined protection and administration of the 4 medicine, and explored any associations amongst insurance coverage plan traits, treatment protection, and state insurance policies.
The researchers analyzed publicly obtainable insurance coverage profit documentation from 241 Medicaid-managed plans that provided protection to adults ages 18–64 in 39 states and Washington, DC in 2021.
Based on the findings, for-profit MCPs have been considerably much less more likely to cowl oral naltrexone, acamprosate, and disulfiram, and MCPs that managed behavioral well being internally have been much less more likely to cowl the entire drugs. The plans not often utilized prior authorization and drug amount limits to those medicine—aside from injectable naltrexone, for which 50% of MCPs required one or each of those necessities.
The staff additionally discovered that plans that didn’t cowl all 4 drugs have been partially concentrated in states with giant populations of Black and Hispanic residents, in addition to low-income residents, residents residing in rural areas, and feminine residents. Alcohol-related morbidity and mortality charges disproportionately have an effect on these teams, so making certain entry to the entire FDA-approved AUD drugs may additionally assist mitigate these racial, socioeconomic, and geographical disparities.
Nationwide, AUD impacts greater than 28 million American adults and contributes to will increase in charges of most cancers, coronary heart illness, diabetes, and accidents. The staff hopes the brand new knowledge can inform nationwide efforts to deal with substance use dysfunction by means of prevention and remedy, and finally decrease AUD charges. However potential cuts to Medicaid funding beneath the Trump administration may hinder these targets.
“Medicaid managed care plans play a critical role in ensuring people have access to evidence-based alcohol treatment and behavioral health services,” Dr. Stewart says. “Proposed cuts to Medicaid would reduce access to alcohol and other substance use treatment for Medicaid enrollees.”
Extra info:
Maureen T. Stewart et al, Alcohol Use Dysfunction Remedy Protection and Utilization Administration in Medicaid Managed Care Plans, JAMA Community Open (2025). DOI: 10.1001/jamanetworkopen.2025.0695
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Fewer than half of Medicaid managed care plans present all FDA-approved drugs for alcohol use dysfunction (2025, March 17)
retrieved 17 March 2025
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