It’s Official: Medicaid No Longer Requires Prior Authorization for Buprenorphine

October 4, 2024

The Illinois Department of Health and Family Services (HFS) has issued a notice to remind healthcare prescribers and pharmacies that buprenorphine no longer requires a prior authorization for age or dosage. This policy applies to the Medicaid fee-for-service (FFS) program and managed care organizations (MCOs).

This departmental change was instituted due to a new law that removes prior authorization requirements for higher doses of buprenorphine for treating substance abuse disorder. It also protects a physician’s freedom to prescribe controlled substances as they determine appropriate and most beneficial to their patients.

This legislation is the direct result of a resolution drafted by an ISMS member treating patients who didn’t respond to lower levels of buprenorphine. Due to outdated FDA guidelines, Medicaid and other payers required that prescriptions for higher doses had to receive prior authorization and unfortunately were often denied. Such prior authorization placed unnecessary delays on treatment for these patients, causing life-threatening risks to patients in need of higher doses, and created significant administrative burdens for the physician.

After being approved at the 2024 ISMS Annual Meeting, the ISMS advocacy team took the issue to Springfield, and worked diligently until it was signed into law. It’s a great example of how ISMS members have the ability to affect change in Illinois!

For more information, please contact the Health Research and Policy Division by email.