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Coverage of Medications for the Treatment of Opioid Use Disorder

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Effective Date:

All Prescribers and Pharmacies in the Virginia Medicaid and FAMIS Programs, Managed Care Organizations and the Behavioral Health Services Administrator
Karen Kimsey, Director Department of Medical Assistance Services (DMAS)

The purpose of this bulletin is to remind providers that Medications for Opioid Use Disorder (MOUD) must be provided in accordance with both federal and state regulations.

Virginia Medicaid’s Preferred Drug List (PDL)/ Common Core Formulary includes several Food and Drug Administration (FDA) approved medications for the treatment of Opioid Use Disorder  including the preferred products Suboxone® films and the generic buprenorphine/naloxone tablets. MOUD is the evidence-based treatment for opioid use disorder (OUD), including buprenorphine products.  Note that buprenorphine for the treatment of opioid use disorder (OUD) is required to be written by a buprenorphine waivered prescriber, per the Drug Addiction Treatment Act of 2000 (DATA 2000) who), who is federally required to put his or her Drug Enforcement Agency (DEA) X prescriber number on the prescription. Preferred medications on the PDL do not require service authorization and are available through point-of-sale pharmacy for Medicaid and FAMIS members at minimal to no cost for members.

DMAS has recently become aware of issues filling prescriptions for Suboxone® films at the pharmacy point of sale including concerns related to limited allotments, increased demand and need for these medications, and inconsistent reimbursement rates across the managed care organizations (MCOs). DMAS collaborated with the Substance Abuse Mental Health Services Administration (SAMHSA), Healthcare Distribution Alliance (HDA) and the DEA to facilitate a Summit in January 2022 to understand and begin to address these concerns.  The DEA also recently posted a press release titled:  “DEA’s Commitment to Expanding Access to Medication-Assisted Treatment” which may be located here.

Furthermore, this bulletin serves to notify providers of the following:

  1. Effective May 1, 2022, DMAS is requiring the Medicaid MCOs to pay the drug acquisition cost and dispensing fee for MOUD based on the fee-for-service schedule as defined in 12VAC30-80-40: Payment for covered outpatient legend and nonlegend drugs dispensed by a retail community pharmacy will include the drug ingredient cost plus a $10.65 professional dispensing fee; and


  1. Current data on the worsening opioid epidemic in Virginia and the rationale behind the increased need and demand for MOUD including buprenorphine-containing products such as Suboxone. Prescribers and Pharmacists are encouraged to share the data below with their Wholesalers in the context of requests for increased allocations of buprenorphine-containing products, such as Suboxone.  

Need for Increased Access to MOUD:

  • The Centers for Disease Control recently posted national provisional data indicating that there were an estimated 100,306 drug overdose deaths in the United States during 12-month period ending in April 2021, an increase of 28.5% from the year prior.
  • Virginia is not unique and is also experiencing an increase in fatal overdoses. The Virginia Department of Health’s (VDH) most recent fatal drug overdose report shows that in 2020, all fatal opioid overdoses increased 47.5% from the previous year. The report also shows that in 2020, 83.0% of all fatal overdoses of any substance were due to one or more opioids.         
  • Medicaid is the largest payer for Behavioral Health services and   covers the full continuum of substance use disorder (SUD) treatment services, including MOUD.  In 2017, nearly two million nonelderly adults in the United States had an OUD, and of these adults, nearly four in ten were covered by Medicaid.
  • Thus, DMAS has worked to increase access to MOUD, including the preferred products (Suboxone® films and the generic buprenorphine/naloxone tablets) to actively address the impact of OUD among Medicaid beneficiaries.
  • DMAS implemented the enhanced SUD benefit in April 2017, called Addiction and Recovery Treatment Services (ARTS). Within the ARTS benefit is a new model for treatment of OUD called the Preferred Office-Based Opioid Treatment (OBOT), which incorporates the buprenorphine-waivered prescriber and a co-located licensed behavioral health clinician. The Preferred OBOT sites are approved by DMAS for credentialing with the managed care organizations. The Preferred OBOT model now has 193 approved sites across the Commonwealth.
  • In addition to the Preferred OBOT expansion, there has also been an increase in the number of buprenorphine waivered prescribers in the Commonwealth since ARTS was implemented. The number of waivered prescribers in Virginia increased from 432 prescribers in 2015 to 1,495 in 2020 (a 246% increase).
  • There has also been an increase in the number of individuals with OUD who are eligible for Medicaid due to Medicaid Expansion.  Among Medicaid-covered individuals with an OUD diagnosis, the number of members receiving MOUD treatment increased 53.7% from SFY 2019 to SFY 2020 – a total of 28,981 members – many of these are expansion members.

In order to improve MOUD inventory for preferred products for Virginia Medicaid - Suboxone films, as well as the generic buprenorphine/naloxone tablet - based on the 53.7% increase in patients and the 246% increase of waivered prescribers in Virginia, DMAS encourages pharmacists to contact their pharmaceutical wholesaler to increase their drug allotments for these preferred products and their ability to assist our members through their recovery process.

Pharmacists may refer to the most up-to-date list of Preferred OBOT here:


Questions may be directed to




Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

Through March 29:


As of April 4, 2022:

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996


Service authorization information for fee-for-service members.


Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

Provider Audits

Please continue to adhere to all instructions provided via DMAS or its contractors as it relates to complying with audit processes and procedures.  Conversion to MES will not affect audit protocol.

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE).  In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider.  The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Medallion 4.0

CCC Plus


Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members.

For credentialing and behavioral health service information, visit:, email:,or

Call: 1-800-424-4046

Provider HELPLINE for claims assistance only as of March 26, 2022

Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.



Provider Enrollment and Management Help Desk

Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.




Aetna Better Health of Virginia


Anthem HealthKeepers Plus


Molina Complete Care


1-800-424-4524 (CCC+)

1-800-424-4518 (M4)

Optima Family Care


United Healthcare


1-844-752-9434, TTY 711

Virginia Premier

1-800-727-7536 (TTY: 711),