Alabama Medicaid Pharmacy Opioid Dependence Treatment 2025

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Under the new benefit, state Medicaid programs must cover all drugs and biologicals approved or licensed by the FDA to treat opioid use disorders, including methadone, along with related counseling services and behavioral therapies.
Dispensing rates for opioids vary widely across states and counties. Opioid dispensing rates were highest in Southern states. States with the highest opioid dispensing rates per 100 persons in 2023 include Arkansas (71.5), Alabama (71.4), Mississippi (63.1), and Louisiana (62.7).
Medicaid will NOT pay for: Cosmetic surgery or procedures. Dental services for adults (age 21 and older), except pregnant adult recipients through 60 days postpartum.
Medicaid Policies Related to Opioids The Alabama Medicaid Agency (AMA) requires prior authorization for beneficiaries with chronic pain (with some exceptions) to receive sustained release oral opioids.
Opioid Cumulative Daily Morphine Milligram Equivalents (MME) Limit MME Decrease. Effective April 1, 2024, the Alabama Medicaid Agency (Medicaid) will implement hard edits on cumulative daily MME claims exceeding 120 MME/day.
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To qualify for Medicaid in Alabama, parents must earn less than 18 percent of the federal poverty level (or less than $4,650 for a family of three annually). * Adults without dependent children are not eligible for Medicaid at all.
Alabama Medicaid covers buprenorphine/naloxone tablets and buprenorphine tablets under FFS plans with the following limitations: Alabama covers Suboxone, buprenorphine/naloxone tablets, and buprenorphine tablets as a pharmacy benefit under FFS plans.

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