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New Jersey Medicaid Waives Prior Authorization Requirement for MAT

April 03, 2019

New Jersey’s Department of Human Services announced this week that the state’s Medicaid plans will no longer require prior authorization before patients can access medication-assisted treatment for opioid use disorder.

The decision comes as a study was released this week indicating that more low-income people on Medicaid who are addicted to opioids are getting diagnosed and treated with effective medication as a result of the Affordable Care Act.

Prior authorization for MAT frequently is a requirement for state Medicaid programs, although requirements for specific medications used for such treatment can vary by state. In 2018, for example, New Jersey was one of 40 states to require prior authorization for buprenorphine, according to a report published by the Substance Abuse and Mental Health Services Administration. SAMHSA lists about 1,200 practitioners in the state who treat opioid dependency with buprenorphine.

The New Jersey Medicaid program serves 1.7 million residents, according to a New Jersey DHS news release.

Removing the prior authorization requirement for MAT is one of several initiatives being enacted by the state’s DHS to combat the opioid epidemic. Other measures include:

  • Requiring residential treatment facilities that receive Medicaid payment to provide access to MAT by July 1
  • Investing in training more primary care physicians, nurse practitioners and physician assistants to provide MAT for opioid addiction
  • Offering new Medicaid payment incentives for primary care providers to offer MAT
  • Funding Medicaid Centers of Excellence for opioid treatment at Rutgers New Jersey Medical School and Cooper Medical School of Rowan University
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