April 21, 2022

New York Medicaid: Updated MAT formulary effective as of March 22, 2022

Updated MAT formulary now in effect

As of March 22, 2022, an updated single statewide medication assisted treatment (MAT) formulary is in effect. In accordance with Social Services Law Title 11, Section 364-j (26) (b), managed care providers shall not require prior authorization for any buprenorphine products, methadone or long-acting injectable naltrexone for detoxification or maintenance treatment of a substance use disorder prescribed according to generally accepted national professional guidelines for the treatment of a substance use disorder.

Single statewide MAT formulary effective March 22, 2022
Please take note of the updated MAT formulary as outlined below. 

Drugs Coverage Parameters
Opioid Antagonists*
naloxone (syringe, vial)
naltrexone
Narcan® (nasal spray)
naloxone nasal spray
Kloxxado™
N/A
Opioid Dependence Agents - Injectable*
Sublocade®
Vivitrol®
N/A
Opioid Dependence Agents- Oral / Transmucosal*
buprenorphine (tablet)
buprenorphine/naloxone (tablet)
Suboxone® (film)
buprenorphine/naloxone filmZubsolv®
  • Refer to PDL for QL for each formulation   
  • Prior Auth (PA) required for opioid therapy for members established on opioid dependence therapy
  • Prior Auth (PA) required for initiation of a CNS stimulant for members established on opioid dependence therapy **
*All agents subject to FDA approved quantity /frequency /duration limits. **Added per NYS Nov. 2021 DURB recommendation.

Download the latest MAT formulary to share this news with your peers. 

Prior authorization guidance
For opioid antagonists and opioid dependence agents:

  • Prior authorization will not be required when prescribed according to generally accepted national professional guidelines for the treatment of a substance use disorder
  • Prior authorization may be required if utilization is inconsistent with FDA package labeling, such as if frequency/quantity/duration limits are exceeded
  • Prior authorization required for opioid therapy for members established on opioid dependence therapy
  • Prior authorization required for initiation of a CNS stimulant for members established on an oral/transmucosal opioid dependence therapy

Questions?
Review the latest New York Medicaid Update article for additional information from NYSDOH. Consult the UHCNY preferred drug list for prescription guidance.

For answers to specific questions, please email northeastprteam@uhc.com

PCA-22-01006-C&S-News