Medication Assisted Treatment (MAT) Formulary

Effective October 1, 2021, the Department of Health implemented a single statewide Medication Assisted Treatment (MAT) formulary for Opioid Antagonists and Opioid Dependence Agents across Medicaid Fee-for-Service (FFS) and Managed Care per the enacted budget for State Fiscal Year 2020-2021. Under this statewide formulary, Medicaid FFS and Managed Care members will follow a single formulary and coverage parameters are consistent across the Medicaid Program. For additional guidance regarding this implementation and to support troubleshooting, please review the MAT Formulary within the MAT Formulary Resources & Materials section of the website below.

The New York State Executive Budget for State Fiscal Year 2020-2021, in accordance to § 367-a (7) (e) of Social Services Law, enacts a statewide formulary for Opioid Antagonists and Opioid Dependence Agents for Medicaid Managed Care (MC) Plans and Medicaid Fee for Service (FFS) Program. Under this statewide formulary, Medicaid MC and FFS members will follow a single formulary and coverage parameters are consistent across the Medicaid Program.

On December 22, 2021, Governor Hochul signed Chapter 720 of the Laws of 2021. This law amends Social Services Law and the Public Health Law, in relation to medication for the treatment of substance use disorders. Effective March 22, 2022, prior authorization will not be required for medications used for the treatment of substance use disorder when prescribed according to generally accepted national professional guidelines for the treatment of a substance use disorder.