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Methadone Maintenance Treatment Coverage for Opioid Use Disorder to Begin Upon Renewal

September 12, 2017

UnitedHealthcare has implemented utilization management strategies for long-acting opioids to help minimize the overuse of opioids while maintaining access to the right treatment for those struggling with an opioid use disorder. In 2017, we have seen significant improvement in utilization including:

  • A 18 percent drop in the number of members utilizing a long-acting opioid
  • A 26 percent drop in the number of days a patient utilizing a long-acting opioid has treatment
  • A 14.5 percent drop in the average dose per day for long-acting opioids

Methadone Maintenance Treatment
Prior to 2017, coverage for methadone maintenance treatment for opioid use disorder was standardly excluded from UnitedHealthcare fully insured plan designs unless otherwise mandated by state law.

Methadone maintenance helps those diagnosed with opioid use disorder:

  • As part of a medication assisted treatment (MAT)
  • Is both clinically effective as well as cost effective
  • Supports mental health parity for plans that cover methadone when used for medical purposes

Benefit Change to Cover Methadone Maintenance Treatment for Opioid Use Disorder
Effective on the dates provided below, UnitedHealthcare will implement a benefit change to cover methadone maintenance for opioid use disorder. Upon renewal, Methadone maintenance treatment for opioid use disorder will now be covered as a standard benefit for UnitedHealthcare fully insured and self-funded business as follows: 

Fully insured
Large Group: Effective upon renewal for plan years starting on or after July 1, 2017
Exceptions: Jan. 1, 2017, for New Mexico; March 1, 2017, for Washington
Small Group: Effective upon renewal for plan years starting on or after Jan. 1, 2017

Self-funded
Effective upon renewal for plan years starting on or after Jan. 1, 2018

Methadone treatment for pain continues to remain a standard covered benefit for fully insured and self-funded business.

For more information on how UnitedHealth Group is confronting the opioid epidemic, review our July Consultant Connection article.

Opioid Webinar Replay
Learn more about our strategies and multi-tiered approach to prevent, treat and improve opioid-related outcomes by listening to our Opioid Webinar replay.

Contact your UnitedHealthcare representative with questions.