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Despite strong evidence that medications for opioid use disorder and overdose (MOUDs) are effective, research indicates that many people with opioid use disorder (OUD) do not receive them. Though access to these treatments is especially important in Medicaid, because Medicaid covers a large share of those with OUD and most enrollees are in managed care, no estimates are available on MOUD prescriptions paid via managed-care versus fee-for-service arrangements in Medicaid. Thus, we estimate Medicaid enrollment by payment arrangement and use Medicaid State Drug Utilization Data to calculate MOUD prescriptions per 1,000 enrollees for buprenorphine, naloxone for reversing opioid overdose, and naltrexone. We find the following:

• On average, the numbers of MOUD prescriptions per 1,000 Medicaid enrollees were similar in states paying for MOUDs in fee-for-service arrangements and in states primarily paying for MOUDs through managed care.
• However, prescriptions per 1,000 Medicaid enrollees varied substantially within these two groups of states, suggesting enrollees may face other barriers to accessing MOUDs.

To learn more about our methodology, see the accompanying technical appendix.