MassHealth Issued Managed Care Provider Bulletin on Prior Authorization for Suboxone

MassHealth has issued Managed Care Entity Bulletin 17: Prior Authorization and Utilization Management for Suboxone® (buprenorphine/naloxone). To facilitate the provision of medically necessary medication to treat substance use disorders, EOHHS is establishing the following requirements effective immediately.

Utilization Management including Prior Authorization for Suboxone® (buprenorphine/naloxone)

MassHealth Managed Care Entities (MCEs), including Managed Care Organizations (MCOs), Accountable Care Partnership Plans (ACPPs), One Care plans, Senior Care Options (SCOs), and the Massachusetts Behavioral Health Partnership (MBHP) must provide access to at least one buprenorphine/naloxone treatment at Suboxone® equivalent doses of 24 mg/day or less without prior authorization.

While MCEs may continue to impose quantity limits on buprenorphine/naloxone treatments, any such quantity limits must accommodate this rule, regardless of dosage strength. Therefore, if an MCE imposes quantity limits, the MCE must still allow for up to a total daily dose equal to or less than 24 mg without prior authorization.