Oklahoma Medicaid recipients can now access a long-acting medication to treat opioid use disorder with fewer barriers.
The Oklahoma Health Care Authority (OHCA) has implemented a new value-based agreement for Brixadi, a weekly or monthly injectable medicine that treats opioid use disorder. Under the new agreement, SoonerCare members no longer need prior authorization to receive the medication.
Value-based agreements tie the cost of medical services or prescription drugs to treatment outcomes and other measures of effectiveness, rather than paying solely for the quantity of care delivered.
The change means physicians can prescribe Brixadi to eligible SoonerCare patients without waiting for case-by-case approval from the agency, said OHCA Chief of Staff Christina Foss.
"SoonerCare members tend to be at a higher risk of substance use disorder than other Oklahomans, which is why it is so important that we really meet them where they're at and provide life-saving care with as few barriers as possible," Foss said.
OHCA has processed 300 Brixadi claims for Medicaid recipients since the new agreement took effect in July, according to an agency spokesperson.
Brixadi is a long-acting form of buprenorphine, a medication used to treat opioid use disorder. It is administered by healthcare providers as part of a comprehensive treatment plan that can include counseling and behavioral therapy.
Medications to treat opioid use disorder, including buprenorphine, are evidence-based treatments that can reduce the risk of overdose and death. Research has found that people receiving medication treatment have substantially lower mortality rates than those who receive no medication treatment.
According to OHCA, removing prior authorization requirements for Brixadi may also help patients overcome common obstacles to recovery, including missed doses, difficulty adhering to daily medication schedules and disruptions in care. Foss said the change will be especially beneficial for SoonerCare members in rural and underserved areas, where daily dosing requirements can be difficult to maintain.
She said the move is part of a sustained agency effort to pioneer value-based agreements that benefit Oklahomans. The state Medicaid agency reports it was the first in the nation to implement a value-based purchasing agreement for prescription drugs in 2018.
The Brixadi agreement is tied to key health outcomes, including fewer opioid-related hospitalizations and emergency room visits among SoonerCare patients. If the medicine doesn't deliver on those metrics, OHCA will recoup funds through higher rebates.
Medicaid is the largest payer of opioid use disorder treatment in the U.S. It covered medicine for nearly half of all non-elderly adults in the U.S. with opioid use disorder in 2023, according to the health policy research group KFF.
In Oklahoma, more than 1 million Oklahomans rely on SoonerCare, but new work requirements mean as many as 250,000 are at risk of losing coverage.
Overdose deaths in the state declined by 43% last year, according to preliminary data from the Centers for Disease Control and Prevention. It was one of the most significant drops in overdose deaths across the nation, which health experts attribute, in part, to increased access to treatment.
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