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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.”

3 Responses to this article

  1. 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.

  2. Carlos / 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.

  3. docbarry / 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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