State Law

Delaware Code-Title 18-Chapter 35-Subchapter III. Provisions Applicable to Group and Blanket Health Insurance

08/01/2023 Delaware Section 3571X

Medication assisted treatment for drug and alcohol dependencies

Medication Assisted Treatment-Prior Auth.

(a) For purposes of this section, “medication-assisted treatment” means the use of U.S. Food and Drug Administration-approved medications, in combination with counseling and behavioral therapies, to provide a whole patient approach to the treatment of drug and alcohol dependencies.

(b) If group health insurance coverage provides prescription medication benefits for the treatment of mental illness and drug and alcohol dependencies, a health insurer must place at least 1 formulation of a medication-assisted treatment on the lowest tier of the drug formulary developed and maintained by the carrier, including each of the following:

(1) Buprenorphine.

(2) Naltrexone.

(3) Naloxone.

(4) A product containing both buprenorphine and naloxone.

(c) A health insurer that provides coverage for prescription drugs must cover the fees associated with the administration or dispensing of methadone dispensed at an opioid treatment program as defined under 42 C.F.R. § 8.2.

(d) A health insurer shall provide benefits under this section as follows:

(1) Not impose a prior authorization requirement.

(2) Must authorize coverage of prescription medicine without imposing a step therapy requirement for at least 1 formulation of each prescription medication for medication-assisted treatment that is on each tier of the drug formulary developed and maintained by the health insurer.