Two recent webinars hosted by the National Council for Behavioral Health outlined barriers to adoption of medication-assisted treatment (MAT) as well as solutions. The modality is widely accepted for opioid use disorders based on the evidence and is recommended in conjunction with counseling.
Lack of health insurance coverage is most often cited as a barrier to treatment, which speaks to the cost issue. All state Medicaid programs cover buprenorphine, however, not all programs cover all the MAT medication options. Lack of buprenorphine providers also inhibits access for patients.
Insurance provider utilization management processes can present logistical barriers and deterrents for treatment. Some coverage plans might include prior authorization, dosage limits or “fail first” requirements. In the past year, several large commercial insurers have abandoned such processes to allow more immediate access.
From an administrative standpoint, coverage policies can be tricky. For example, a patient might use a medical benefit to visit a prescribing physician but then use a pharmacy benefit to obtain the medication.
Stigma is not inconsequential. Beyond the stigma of addiction itself, many hold beliefs that MAT “substitutes one drug for another” and therefore is not treatment but a continuation of addiction. In fact, the secretary of the Department of Health and Human Services was criticized for his comments in early May that seemed to reflect that attitude. HHS later clarified that it is open to many treatment options.
SAMHSA has a number of toolkits and resources for organizations implementing MAT services, including a recently released pocket guide for prescribers.