Photo Courtesy of Workit Health
For a health plan, the math on opioid use disorder looks straightforward: medication keeps members in treatment, treatment reduces costly emergencies, and the medication itself is inexpensive. The complication is what happens between approval and the pharmacy counter, where coverage rules can stall the very prescriptions a plan has agreed to pay for.
Workit Health, a telehealth provider treating opioid and alcohol use disorder, has spent part of its research effort documenting that middle stretch, and the findings point to a problem that sits partly inside the insurance system itself.
A study published in JAMA Network Open in August 2025, based on a survey of 601 patients in telemedicine treatment, ranked the obstacles people hit when filling a buprenorphine prescription. After the pharmacy simply not stocking the drug, the next most common barrier was coverage: prior authorization, plan restrictions, and related insurance hurdles that kept patients from collecting a medication their prescriber had already approved.
The Patients Plans Are Already Paying For
The population affected is not, for the most part, uninsured. In a separate Workit Labs feasibility study of 337 adults beginning treatment in Texas, about 71 percent were commercially insured. These are members already on a plan’s books, already approved for a covered medication, who still meet friction at the point of sale. For an administrator, that is a different problem than extending coverage to the uninsured. It is a question of whether existing benefits actually reach the people entitled to them.
The cost logic runs in the plan’s favor when treatment holds. Buprenorphine reduces cravings and lowers the risk of fatal overdose, and patients who stay in treatment are less likely to cycle through emergency departments and inpatient stays. Retention, in that sense, is more than a clinical measure. It is the variable that decides whether a plan’s spending on addiction care produces a return.
Outside research lends some support to that case. A 2024 study in Telemedicine and e-Health that followed veterans receiving buprenorphine through telehealth reported lower emergency department use, fewer hospitalizations, and lower mortality than among those treated in person alone. A separate 2025 analysis in the Journal of Substance Abuse Treatment found that telehealth treatment held retention close to clinic-based care while cutting the travel and time costs that often pull lower-income patients out of treatment. Those are the downstream expenses that make early disengagement costly for a plan.
Workit Health’s research has tried to attach evidence to the retention variable directly. Its February 2025 study in Addiction Science & Clinical Practice reported that patients who received buprenorphine through delivery pharmacies were more likely to remain in treatment than those who collected it in person. The company frames the result as an early finding from a single state rather than a general claim, but the direction is the kind of signal a payer evaluating virtual care would want to see.
What Administrators Are Weighing
The case Workit makes to plans rests less on any single statistic than on where the friction lives. According to the company, roughly three-quarters of its opioid patients had never received medication for addiction before joining, and most arrive with co-occurring conditions; Workit Health data put depression diagnoses at about 78 percent and positive anxiety screens at 81 percent at intake. A plan covering that population is paying for more than a prescription, and a model that keeps members engaged across those conditions changes the arithmetic of what it gets back.
Workit also points to public-payer arrangements as evidence the model can work within budget limits. The company says it has contracted with Ohio’s Department of Mental Health and Addiction Services and with a Texas program to provide treatment to uninsured residents, operating across multiple states. Those partnerships are the company’s own account rather than independently audited results, but they signal an effort to fit virtual addiction care into how public and commercial plans actually pay.
None of this resolves the coverage friction the research identified. Prior authorization and plan restrictions remain decisions plans make, and a telehealth provider can route around a missing pharmacy more easily than it can rewrite a benefit design. What the evidence does is reframe the administrator’s question. The issue is not only whether to cover addiction medication, but whether the path from a covered approval to a filled prescription is short enough that members complete it. Coverage on paper means little if a member gives up before the medication arrives.