NQF, BCBS release practical guidelines extending MAT for opioid use disorder

NQF, BCBS release practical guidelines extending MAT for opioid use disorder

August 07, 2019

NQF, BCBS release practical guidelines extending MAT for opioid use disorder

Addiction Substance Abuse

The death toll from drug overdoses continues to escalate in the U.S. More than 702,000 people succumbed to drug overdoses between 1999 and 2017. In 2017, more than 70,000 deaths from drug overdoses were reported making it the leading cause of injury associated deaths in the U.S. Unfortunately, 68 percent of these deaths were attributed to an illicit or a prescription opioid. According to the Centers for Disease Control and Prevention (CDC), the deaths from opioid overdoses increased from 2016 to 2017.

Although, treatment plans for substance abuse and addiction are available throughout the country, outcomes from rigorous clinical trials have demonstrated that medication-assisted treatment (MAT), in combination with behavioral therapies, is the most successful in producing solid abstinence and treatment retention results compared to psychosocial treatments administered alone or with a placebo. Data has shown that the use of MAT has resulted in fewer emergency department visits and overall lower health care utilization. Besides, patients receiving MAT are less likely to die due to an overdose, and are more likely to maintain long-lasting sobriety.

In spite of this, patient access to MAT is often limited. To bridge this gap, the Blue Cross Blue Shield Association (BCBSA) and the National Quality Forum (NQF) have joined hands and recently released a set of guidelines to help payers, health care providers, and policy makers ensure that more and more patients have an access to MAT.

Multiple barriers prevent patients from accessing MAT

Regulatory and policy barriers enforced by Medicaid restricting access to MAT include:

  • Lifetime or annual limits on medication
  • Limits on prescribed dosages
  • Requirements for initial authorization and reauthorization
  • Minimal coverage for counseling


MAT remains underutilized till date because multiple barriers contribute to its low access. Some of these are:

  • A mistaken belief that MAT replaces one addiction with another
  • Inadequate number of trained treatment prescribers, often leading to inappropriate dosing of MAT, resulting in treatment failure
  • A preference for abstinence over medication
  • Regulatory and policy barriers enforced by Medicaid programs and the organizations associated with them leading to reduced utilization of MAT
  • Limited coverage for buprenorphine under some major commercial insurance plans (buprenorphine, naltrexone, and methadone are medications that are used in MAT)
  • Fewer insurance plans offering coverage for naltrexone
  • Restricted coverage of methadone, especially when offered through opioid treatment programs

MAT has proven to be highly efficacious in treating patients struggling with opioid use disorder (OUD). When prescribed, administered, and monitored under experts, MAT is considered to be cost-effective and safe. Further, it offers a greater reduction in overdose associated risks, improves social functioning of the patient, and lowers the risk of contracting infectious diseases transmitted through the use of injectable preparation of illicit drugs.

NQF and BCBSA envisage expanded access to MAT

Patient access to MAT can be increased by:

  • Encouraging provider support
  • Creating community partnerships
  • Enhancing organizational support

NQF and BCBSA experts are hopeful of expanding MAT to a large patient population by offering support to the medical professionals in overcoming challenges to accessibility. Earlier this year, leading industry patrons, including the Kaiser Family Foundation (KFF) released a set of guidelines for expanding access to MAT. Some of the factors that can expand patient accessibility to MAT include:

  • Encouraging provider education so that they are trained in the administration of MAT
  • Creating community partnerships with local hospitals and social service organizations
  • Enhancing organizational support to use the maximum available grant funds for training and treatment

Some states are also working hard on exterminating the requirements for prior authorization which is sometimes indispensable to access MAT and other treatment options for OUD.

The guideline was formulated by combining insights received from health care administrators, patients, addiction treatment specialists, pharmacists, payers, treatment facility staff, employer groups, federal agencies, and criminal justice system. The experts who created these have urged the payers, practitioners, health care delivery organizations, and community organizations to make use of the resources and strategies outlined in the guide to strengthen their approach towards OUD treatment.

Road to recovery

One can gain access to MAT by enrolling into a licensed opioid addiction treatment facility. Oftentimes, the initial step of the treatment involves a detoxification process during which the body is rid of unwanted drugs and their metabolites. This process sets the stage for treatment.

If you or a loved one is battling an addiction to drugs like opioids and is looking for a licensed detox treatment center, then get in touch with the Invictus Health Group. Our expert members can guide you to the right treatment center offering customized detox treatment. For more information, call our 24/7 helpline 866-548-0190 and speak to a member of our team. You can also chat online to a representative for more information about how detox treatment rehabs can help set you on the path to recovery.

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