Kentucky Medicaid Provider to Stop Paying for Buprenorphine to Treat Opioid Addiction

A Medicaid provider in Kentucky has announced it will stop paying for the opioid addiction medication buprenorphine. A doctor who prescribes the medication says the company’s decision could lead to serious complications, relapse and even overdose deaths.

The company, Coventry Cares, is one of four companies hired by Kentucky to manage Medicaid. It announced this week that while it will no longer pay for the medicine, it does not intend to immediately stop coverage for patients already taking the drug, The Lexington Herald-Leader reports.

“It’s a cruel thing to do to people,” Dr. Michelle Lofwall, an addiction specialist and Assistant Professor at the University of Kentucky, told the newspaper. “This is a population that is poor. It’s not like they can afford to pay it out of pocket.” A 30-day supply of the drug can cost more than $450, the article notes.

Dr. Lofwall says that if someone were to suddenly not be able to take buprenorphine, they would experience opiate withdrawal. “They will be at risk for relapsing and going back to using illegal opioids,” she said. “Whenever you are using illegal opioids, there is a risk of overdose and death.”

Coventry said it is halting coverage of buprenorphine because under Kentucky’s Medicaid program, only pregnant women, women who recently gave birth and those under age 21 are eligible for addiction treatment.

A spokeswoman for Kentucky’s Cabinet for Health and Family Services, which oversees Medicaid, said the agency believes Coventry’s decision violates its contract with the state.

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    May 10, 2017 at 9:04 AM

    Don’t you love how RJ’s Mom is more pragmatic, wise, and more firmly based in reality than the good Dr Shore? “Addiction is a chronic brain disease”, based on what study or finding?
    Addiction is a mental disorder.
    Addiction is depression.
    Addiction is substance abuse.
    Rather easy to make generic unverified statements of grandeur is it not… Normalizing addiction and substance abuse with cancer, diabetes, etc is wreckless, asinine, and uneducated.

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    Michael W. Shore, M.D.

    May 11, 2012 at 12:59 PM

    This presumptive decision to not cover Buprenorphine should be challenged using whatever means possible, lest other Medicaid programs in oter states follow suit. It is shortsighted and potentially lethal to the patient given the increasing problem with opiate related overdose deaths. Futhermore, it is well established that this treatment actually saves several times the cost in healthcare and legal related costs. Yes, $450. per month is a typical cost for a patient maintained on buprenorphine, which is less than 1/4 the cost of one visit to the
    Emergency Room to treat the patient who has overdosed or had other complications from illicit drug use. Lets not forget the ongoing costs treating HIV and Hepatitis C from ongoing use by addicts, nor the enormous cost of hospitalization for a patient who develops endocarditis from IV related infection from illicit drug use. Then there is the cost of incarceration and all the othe costs when untreated and thus unstable patients enter into the criminal jutice system. Then there is the difficult to quantify real cost to the family, children and relatives when the return to active addiction causes loss of employment, loss of housing and the cost and burden of social service agencies needing to monitor and get involved with the relapsing patient. Buprenorphine works, is extremely cost effective and enables the addict to achieve real stability. Addiction is a chronic brain disease, and requires ongoing management and treatment. I’d like to see these Medicaid programs discontinue or not cover treatment for the chronic diseases of Diabetes, Hypertension, Cancer and others. Again, this illustrates te “enigma of stigma”. Dr. Shore

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    RJs Mom

    May 11, 2012 at 12:05 PM

    People can’t afford $450 for “treatment” pill but somehow find a way for their habit. Shocking! Maybe if people had to pay for the pill they wouldn’t be selling their pills to make $$$ to buy their opiate of choice now would they?

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