Medication Assisted Treatment (MAT)

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

Outpatient Care

MAT is a covered benefit under an opioid treatment program or in an office-based opioid treatment (OBOT) setting for TRICARE beneficiaries who require medically supervised OUD treatment. Medication prescribed under an OBOT is covered under the TRICARE pharmacy benefit and may include separate costs.

Treating providers for MAT must have certification from the Drug Enforcement Administration (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. 

Note: The DEA will allow for the prescription of controlled medications through telemedicine through Nov. 11, 2023, or through Nov. 11, 2024, if the practitioner-patient telemedicine relationship was established on or before Nov. 11, 2023.

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

MAT 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.