Opioid Treatment Program

​​Click here for full service definition information in the Clinical Coverage Policy

The Opioid Treatment Program (OTP) is a service designed to assist in the detoxification and rehabilitation process from opiates. This is done through use of methadone or another drug approved by the Food and Drug Administration (FDA) for the treatment of opiate addiction. The program must be specifically licensed to provide this treatment. This should be provided in conjunction with rehabilitation such as therapy and medical services. The OTP provider should closely coordinate with any other prescribers or treatment providers to ensure continuity of care.

Specifically this includes

  • Suboxone (opiate withdrawal and relapse maintenance)

  • Methadone (opiate relapse maintenance)

Intended populations

  • Members with an Opioid Use Disorder diagnosis that less restrictive treatment has not been effective for in recovery from opioid addiction

  • High risk Opioid User, including Intravenous (IV) drug use

Recommended Best practices 

Desired outcomes 

  • Improved functioning in life skills.

  • Reduction in any psychiatric symptoms (if present)

  • Reduced risk for relapse as evidenced by improvement in known relapse risk factors

  • Reduction in health and safety concerns

  • Reduction of high risk behaviors

Management Strategies

  • Core Management Strategies

  • Authorization Guidelines

  • Conduct focused Utilization Review of providers based upon over/under utilization, negative outcomes (e.g., high use of acute care or crisis services), concerning incidents and/or grievances, and other data suggesting a team's practices are an outlier compared to the community standard of care. For OTP providers, frequency of routine Utilization Review will be determined by average provider census.