U.S. payment policy for medications to treat opioid use disorder: landscape and opportunities

Offering patients medications for opioid use disorder (MOUD) is the standard of care for opioid use disorder (OUD), but an estimated 75-90% of people with OUD who could benefit from MOUD do not receive medication. Payment policy, defined as public and private payers’ approaches to covering and reimbursing providers for MOUD, is one contributor to this treatment gap. We conducted a policy analysis and qualitative interviews (N=21) and surveys (N=31) with U.S. MOUD payment policy experts to characterize MOUD insurance coverage across major categories of U.S. insurers and identify opportunities for reform and innovation. Traditional Medicare, Medicare Advantage, and Medicaid all provide coverage for at least one formulation of buprenorphine, naltrexone, and methadone for OUD. Private insurance coverage varies by carrier and by plan, with methadone most likely to be excluded. The experts interviewed cautioned against rigid reimbursement models that force patients into one-size-fits-all care and endorsed future development and adoption of value-based MOUD payment models. More than 70% of experts surveyed reported that Medicare, Medicaid, and private insurers should increase payment for office- and opioid treatment program-based MOUD. Validation of MOUD performance metrics is needed to support future value-based initiatives.