Ensure access to MOUD and MAUD

Congress should amend the Public Health Service Act to include the following additional insurance protections that increase access to MOUD and MAUD, which have been proven to save lives.[1] Specifically, Congress should ensure the following protections are codified:

• Health plans and issuers may not exclude coverage of any Food and Drug Administration (FDA) approved medication for the treatment of substance use disorders (SUDs) if such medication is medically necessary according to the most recent National Practice Guideline on the Use of Medications for the Treatment of Addiction Involving Opioid Use established by American Society of Addiction Medicine (ASAM).[1]
• All FDA-approved medications for the treatment of SUDs should be placed on the lowest tier of a health plan or issuer’s prescription drug formulary.[1]
• Health plans and issuers may not impose step therapy requirements on MOUD/MAUD before coverage is approved.[1]
• Health plans and issuers may not exclude coverage for any prescription medication approved by the FDA to treat SUDs and any associated counseling or wraparound services because such medications and services were court-ordered.[1]

While the  Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)  improved access to MH/SUD treatment and services, patients still encounter obstacles in accessing care, including MOUD/MAUD.[2] Many barriers may impact the availability of these medications including stigma, the availability of prescribers, and insurance benefit designs.[2] MOUD/MAUD have been proven to be an effective treatment for MH/SUDs, but it can be costly for people who are uninsured or underinsured.[3] Having quality health insurance coverage can make treatment more affordable and accessible.[4] Given the recent increases in overdose deaths and alcohol use, Congress should ensure health insurance coverage provides access to critical SUD medications.