Medications for opioid use disorder (MOUD) are the gold-standard treatment, but less than 30% of people with opioid use disorder receive them. Financing barriers play a key role in this lack of access to MOUD, such as insurance requirements for prior authorization, and mismatches between fee-for-service financing models and MOUD care delivery structures.
We produced a series of resources that work together to help you further your understanding of the basics of MOUD financing in the United States in 2023 and learn about opportunities for reform and innovation.
MOUD Financing
We conducted a study of financing rules that surveyed U.S. MOUD financing experts to characterize MOUD insurance coverage across major U.S. insurer categories and identify opportunities for reform and innovation. You can read the published analysis here.
Citation: McGinty EE, White SA, Eisenberg MD, Palmer NR, Brown CH, Saloner BK. US payment policy for medications to treat opioid use disorder: landscape and opportunities. Health Affairs Scholar. 2024;2(3). doi:10.1093/haschl/qxae024
The MOUD infographic provides an overview of the research paper. To share the image, right-click on it and select "save image as" to save the file to your computer. We encourage you to use @HEALData2Action in your Instagram and X posts in order to connect with people and organizations who are dedicated to improving MOUD treatment in the US.
This guide describes the basics of financing for MOUD in the United States in 2023, including definitions of key terms and concepts; a summary of four domains of MOUD financing--coverage, provider reimbursement model, prior authorization, and co-payment requirements--across traditional Medicare, Medicare Advantage, Medicaid, and private insurance; and descriptions of three innovative payment models.