Many Medicaid Programs Hinder Access to Opioid Addiction Treatment: Report

Many Medicaid programs make it difficult for people addicted to opioids to receive medications to treat their addiction, according to a new report. The American Society of Addiction Medicine (ASAM) says private insurance companies also are restricting access to these treatments.

The report finds wide variation among states in their coverage of medication to treat opioid addiction, MedPage Today reports. Many states require patients to try other treatments before covering addiction medications. Private insurance companies use prior authorization and other techniques to restrict patients’ access to drugs including buprenorphine, methadone and naltrexone, according to the report.

Twenty-eight states cover all three drugs, but the extent of coverage varies greatly among the states, the authors noted. Requirements needed to access the medications also differ among states. In 42 states, prior authorization is required by Medicaid for buprenorphine. Many programs have coverage limits for lifetime benefits and daily doses.

ASAM also released a report on opioid medications, which found that they show substantive evidence of effectiveness and safety.

“These reports show that we could be saving lives and effectively treating the disease of addiction if state governments and insurance companies remove roadblocks to the use of these medications,” ASAM President Stuart Gitlow, MD, said in a news release. “State lawmakers and insurance company administrators would never deny needed medication to people suffering from other chronic diseases, like diabetes and hypertension. But it happens every day to people with addiction.”

Thomas McLellan, an author of the opioid medication effectiveness report, who is CEO of the Treatment Research Institute and former Deputy Director of the White House Office of National Drug Control Policy said, “The fact that patients are frequently denied access to the full spectrum of treatment options for addiction is unethical and would constitute malpractice in other medical specialties and chronic disease. Treatment of addiction must be raised to the same medical and ethical standards as treatment for other chronic diseases.”

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    January 8, 2017 at 5:43 AM

    Addiction is a chemical imbalance which affects the Central Nervous System which means it is a HORMONAL IMBALANCE that can be treated with pharmacology like ANY OTHER HORMONAL IMBALANCE. THE SECRET IS OUT! The time has come to treat those SUFFERING with the same compassion and dignity as we would any other sick individual AND STOP EXPECTING THOSE SUFFERING WITH CHEMICAL IMBALANCES TO MAGICALLY HEAL THEMSELVES! Sadly rehabs have become a CASH COW BIG BUSINESS in America. Comercials still channeling people into ARCHAIC AND IN SOME CASES BARBARIC TREATMENT PROGRAMS THAT DO NOT HAVE A MAGIC CURE! Addiction treatment IS NOT one size fits all illness. Some may be able to totally abstain and some may not able to depending on many factors. RESTRICTIONS and REGULATIONS of the past ARE STILL HINDERING PROPER TREATMENT FOR THOSE IN NEED OF IT which is JUST AS Important abd maybe even more important than as PREVENTION! We must approach this problem from BOTH SIDES SIMULTANIOUSLY otherwise the regulations designed to prevent future addictions wind up also preventing treatment and care! Physicians need the freedom to care for their own patients and the court system SHOULD NOT PLAY DOCTOR! Lets remove all of the barriers so those suffering can once and for all can finally get the proper medical care and attention that ALL OF HUMANITY DESERVES! Lets make treatment affordable so more the people who need it can get help they need and shut down these ARCHAIC FACILITIES that are only looking TO MAKE A BUCK OFF THE SICK AND SUFFERING

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    May 23, 2016 at 10:35 PM

    Thank you for talking about this subject. I am a perfect example of this situation. Suboxone saved my life. Not only that but I am a huge fan of long term Suboxone. But because of the ridiculous guidelines I am constantly denied by insurance and although I will eventually be approved, I cannot wait 2 weeks to get my medication and therefore must pay for it myself. This has practically bankrupted me. I have shelled out over $2000 for medication that my insurance should pay for. Finding a doctor that can prescribe it under the medicaid providers is also a challenge. What really irks me the most is that Molina Florida (my provider) was originally denied as a medicaid provider under the new guidelines. They appealed this decision and fought hard until finally they got approved. I say, “Don’t fight to be a part of this program if you don’t want to take care of your patients.” I was forced to leave my last medicaid provider, Healthy Palm Beaches. Although they had guidelines, it was manageable. Molina will do everything they can to deny you and they do not offer any coordinator or assistance other your regular customer care operator.

    The medical field needs to wake up. I’m so tired of the stigmas that come along with this disease. I also believe there are huge connections of ADD and learning disabilities to opioid addiction. I’m sad that the guidelines make it so impossible but it is good to know that there are certain officials in our corner such as Stuart Gitlow, MD and Thomas McLellan.
    I’m pasting a link to an article I wrote on this issue and how a famous Pop star could of been saved if he had access to this medication. I’m not a medical professional but I have even more credentials, I’ve been a patent for 8 years. I only wish I could make it my career to be a part of these studies to help people.

    Brenda E- I wish the best,commend you and hope you were able to find what you needed to treat all of your needs.
    Carlos- If you find out the exactly guidelines then you can supervise the process of being approved. If your facility is stigmatizing you then find another one under the provider book.
    DocBarry – I understand you too may have frustrations with reimbursements for your services but this article is focusing on the medication. Sure your services will help a person to stay sober but to say ultimately your services will help someone stay sober over the medication, I completely disagree with. I personally experienced every therapeutic option available to man for ten years and yet I did not become fully sober until was on Suboxone. It’s is now 7 years and going strong. I know you spent a lot of time in school but that doesn’t mean medication isn’t necessary for many people fighting opioid addiction.

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    Brenda E

    December 22, 2013 at 12:57 PM

    I have been paying for my methadone out of pocket since 1995. I had been incarcerated twice for writing checks to obtain money to support my drug heroin. I knew the only way I could stay out of jail and live a good life was on the methadone program in which I would be capable of proving to myself and others that I was not using illegal drugs to ease my uneasiness with life. I have lived a very productive life since starting on methadone maintenance. I got my children back early from DHS and have raised them. That person I was when using seems like a distant stranger that I will never have to be in the presence of again.
    IT has been so tough finacially to obtain the methadone that I know my sobriety depends on. My stability with all aspects of the program is key to living a stable life. I am turning 60 years old in a few months and it scares me to think I will have to take more of my fixed income a month to pay the twelve dollars a day to dose plus I live 50 miles round trip from the clinic I attend. I am hoping that now we have some good research in to how the program DOES help with recovery for opiod dependant patients and can be a big savings to the taxpayers in which I am also. Please do know there is a lot of us out there that have done remarkably well on this medication for a disease we have to live with the rest of our lives. And I have Hepatitis C which also needs to be treated and watched.

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    July 1, 2013 at 2:16 PM

    I am finding tremendous amount of difficulties, having Florida Medicaid (medically needy program) and Medicare to pay for the substantial amount of my treatment. It is frustrating when none medical staff attempt to tell doctors and patients what is best for them. Even from a Community Mental Health Program that was designed to help the more economically needy the attitude (and frequently I think the stigma) is getting in the way.
    I think that for Opiate Dependent persons, methadone and Buprenorphine seem to be the most effective and if done well safe treatment. Residential facilities no matter how many public relations the push, the fact is that the relapse rate is a lot higher than they are willing to admit.

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    June 24, 2013 at 8:52 PM

    I treat well over 100 suboxone/methadone patients. I will tell you that I went to school and interned for 13 years to become an LCSW-R; I spent more time working on my PhD, however, while other insurers fluctuate on reimbursement, medicaid varies very little for an LCSW-R providing psycotherapy. While Medicaid pays for the medication, and I’m sure Tom McLelan has an idea how much a month of suboxone costs, or at least an idea, my service, therapy that is, will ultimately be the reason that my patient gets better; whether or not they stay on medication assisted therapy forever is irrelevant as insulin to the diabetic. What is important is the etiology of that addiction, and how has it affected the patient, and can they have a good, high quality of life. I would hope that behavioral health, or mental and emotional health might be just as important, actually, rsearch tells me that in the 21st century, probably more important, but why is it still reimbursed on a second class level?

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