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Medication Assisted Treatment (MAT)

Medication assisted treatment (MAT) is a covered benefit for the treatment of opioid use disorders. It combines drug and mental health therapies, including counseling, to treat substance use disorders such as opioid use disorder. Medication assisted treatment may include drugs such as methadone, Suboxone® (buprenorphine/naloxone), or Vivitrol® (naltrexone) to treat an opioid addiction.

Outpatient Care

Medication assisted treatment is a covered benefit under an opioid treatment program or in an office-based opioid treatment setting for TRICARE beneficiaries who require medically monitored detoxification with access to medical support services. Medication prescribed under an office-based opioid treatment is covered under the TRICARE pharmacy benefit and may include separate costs.

Treating providers for MAT must have certification from the Drug Enforcement Agency (DEA) to prescribe these medications and must adhere to regulations from the Department of Health and Human Services, the DEA, and state and local governments. 

In response to the COVID-19 pandemic, retroactive to March 13, 2020, the Defense Health Agency is temporarily allowing for MAT to be rendered via telemedicine.

Approval Requirements

  • Active duty service members (ADSMs) require an approval from Health Net Federal Services, LLC (HNFS). 
  • All other TRICARE Prime beneficiaries (excluding ADSMs) do not require an approval when seeing a network provider. TRICARE Prime beneficiaries must have an approval from HNFS to a non-network provider unless they choose to use their Point of Service option. 
  • TRICARE Select beneficiaries do not require an approval from HNFS. 

Cost Information

Inpatient Care

Medication assisted treatment may also be covered in an inpatient or partial hospitalization program setting. 

Approval Requirements

  • When provided during an inpatient or partial hospitalization program setting, a separate authorization is not required as it is considered included in that episode of care. See inpatient and partial hospitalization program approval requirements. 

Opioid Management Resources

  • Centers for Disease Control and Prevention (CDC): The CDC offers guidelines for prescribing opioids for chronic pain, along with many other online resources:
    • Provider fact sheet on prescribing guidelines
    • Information for patients
    • Mobile app
    • Interactive training for providers with continuing education credits available
    • Information about Prescription Drug Monitoring Programs (PDMPs)
    • Fact sheets (provider and patient) on urine drug testing (UDT)
  • VA Opioid Safety Initiative (OSI): The VA/DoD offers clinical practice guidelines and guides for patients, and numerous tools for providers.
  • Substance Abuse and Mental Health Services Administration (SAMSA): SAMHSA offers various resources on a number of topics, including medication-assisted treatment (MAT), and a directory of opioid treatment programs. SAHMSA also has a national helpline and other resources for patients.
  • Federal Drug Administration (FDA): The FDA recommends providers consider prescribing naloxone when prescribing opioids.

 

 

Suboxone® is a registered trademark of Indivior UK Limited.
Vivitrol® is a registered trademark of Alkermes, Inc.