Stewart 2025: Medicaid managed care coverage of alcohol medicines

What they tested

Medicaid managed care plans run health coverage for nearly 80% of Medicaid enrollees. Researchers analyzed 2021 benefit data for 241 comprehensive plans, along with other sources, to see which alcohol medicines each one covered.

They looked at acamprosate, disulfiram, oral naltrexone and injectable naltrexone, and at whether plans used utilization management, rules such as prior authorization (approval before the plan pays) and quantity limits. They also checked whether plan features, such as profit status and market share, or state policies were linked to coverage.

What they found

In all, 217 plans (90.0%) covered at least 1 alcohol medicine. Coverage was 203 (84.2%) for oral naltrexone, 175 (72.6%) for injectable naltrexone, 152 (63.0%) for disulfiram and 132 (54.7%) for acamprosate. Only 103 (42.7%) covered all 4.

Prior authorization and quantity limits were rarely applied, except for injectable naltrexone, where 75 plans (42.8%) imposed at least 1 of these requirements.

Limits

• The data are from 2021, and plan coverage can change from year to year.
• It describes what plans reported covering, not whether patients actually got the medicines.

What it means if you're considering naltrexone

In 2021, most Medicaid managed care plans covered naltrexone tablets, while the monthly shot was covered less often and more often came with prior authorization or quantity limits. The authors say these gaps in coverage may limit efforts to get more people prescribed alcohol medicines.