About 37% of all Medicaid managed care plans cover all three medications for treating opioid use disorder (MOUD) that are approved by the U.S. Food and Drug Administration (FDA)—buprenorphine, extended-release naltrexone, and methadone—according to a recent study. The percentage is much lower than anticipated, as the 2018 SUPPORT Act (Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities) includes provisions requiring Medicaid managed care plans to cover all three MOUD for five years, starting October 1, 2020, the study stated.

The analysis was based on coverage policies as of December 2023 for 180 comprehensive Medicaid managed care plans in 30 states and the District of Columbia (D.C.), which covered 37.1 million members in 2023. The 30 states and D.C. were selected because their managed care plans are responsible for managing MOUD pharmacy benefits.

The analysis found that gaps in MOUD coverage in the research results were attributable to several factors, including that MOUD coverage was possibly presented incompletely by the plans in public-facing materials, and that there could be a need to expand Medicaid pharmacy benefits. The findings about the 30 states and D.C. were as follows:

• All three of the medications for MOUD were covered by 37.2% of the plans (67 plans) across seven states: Illinois, New Hampshire, North Carolina, Ohio, Pennsylvania, Rhode Island, and Virginia. These plans covered 17.3 million members.
• In 10 states, no Medicaid managed care plans reported coverage for all three MOUD medications. The report did not state how many plans or the number of affected members were included. These states are Arkansas, Colorado, Delaware, Indiana, Iowa, Kansas, Nebraska, Nevada, Oregon, and Utah.
• Buprenorphine was covered by 97.2% of the plans (175 plans). These plans covered 36.5 million members.
• Extended-release naltrexone was covered by 79.4% of the plans (143 plans). These plans covered 31.8 million members.
• Methadone was covered by 47.2% of the plans (85 plans). These plans covered 19.6 million members.
• For the 30 states and D.C. that were included in the analysis, the study did not report how many medications for OUD were covered by each state plan.

Of the excluded states:

• Ten states were excluded from the analysis because these states do not have comprehensive Medicaid managed care: Alabama, Alaska, Connecticut, Idaho, Maine, Montana, Oklahoma, South Dakota, Vermont, and Wyoming.
• Nine states were excluded from the analysis because the states retain responsibility for pharmacy benefits for substance use disorder treatment: California, Maryland, Michigan, Missouri, New York, North Dakota, Tennessee, West Virginia, and Wisconsin.
• One state was excluded because it is exempt from the SUPPORT Act requirements: Hawaii.

These findings were reported in Coverage For Opioid Use Disorder Medications In Medicaid Managed Care by Christina M. Andrews, Ph.D.; Sage R. Feltus, MS; Constance M. Horgan, ScD; and colleagues. The analysis was based on data from 30 states and the District of Columbia. In these 31 jurisdictions, the Medicaid managed care plans are responsible for the pharmacy benefit for substance use disorder treatment: Arkansas, Arizona, Colorado, Delaware, District of Columbia, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Virginia, and Washington State. The researchers reviewed data posted by Medicaid managed care plans pertaining to coverage of MOUD for adult beneficiaries ages 18 to 64 years in the jurisdictions in which the managed care plans are responsible for managing OUD benefits.

The full text of Coverage For Opioid Use Disorder Medications In Medicaid Managed Care was published on September 5, 2025, by JAMA Health Forum. A free copy is available (accessed October 22, 2025).

OPEN MINDS last reported on Medicaid coverage of MOUD in Medicaid FFS More Likely To Cover Opioid Use Disorder Treatment Than Medicaid Managed Care on November 25, 2022.

For more information, contact: Christina M. Andrews, Ph.D., Associate Professor, Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 344, Columbia, South Carolina 29208; Email: candrews@mailbox.sc.edu; Website: https://sc.edu/study/colleges_schools/public_health/faculty-staff/andrews_christina.php