Opportunities to Improve Opioid Use Disorder and Infectious Disease Services Integrating Responses to a Dual Epidemic: Recommendations

Prior Authorization Policies

Recommendation 3-1: The Centers for Medicaid & Medicare Services (CMS) should withhold approval of
a Medicaid state plan amendment from states that require prior authorization for medications to treat opioid
use disorder. Independent of CMS action, states should remove prior authorization requirements for all Food
and Drug Administration-approved medications to treat opioid use disorder in state Medicaid programs and
state-regulated private insurers, allowing providers to prescribe whichever formulation and dose is best for
an individual patient and without restrictions such as concurrent psychosocial therapy, step therapy, or lifetime limits.

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CHIME Opioid Action Center

710 Avis Drive, Suite 200
Ann Arbor, MI 48108


Phone: 1.734.665.0000


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