Opioid abuse has ruined the lives of millions across the nation, and at times access to comprehensive substance use disorder treatment has lagged behind the need. However, the tide is turning, led by Medicaid plans that are increasing their flexibility to offer medication assisted treatment (MAT) such as buprenorphine and naltrexone –the gold standard of substance use disorder treatment.
Medicaid prescriptions for buprenorphine, for example, shot up from 1.8 million in 2013 to 5.2 million in 2017, according to an October report from the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission.
An accompanying surge was also seen in Medicaid prescriptions for Naltrexone, which jumped from 99,000 to 444,000 over the same timeframe. Further, many states are removing lifetime caps on MAT, recognizing that opioid addiction can be a chronic issue for patients. MAT incorporates a holistic approach to treating a substance use disorder, using both drugs and counseling to lower the risks of overdose and death and improve overall patient outcomes.
Expanding access to MAT through Medicaid programs also underscores the need to protect an important tool that ensures safe patient care – medical management. The drugs used for MAT must be administered by a trained specialist and the patient should be closely monitored to avoid relapse and ensure they are on a long-term path to recover. Additionally, medical management encourages the use of “centers of excellence” that coordinate with specialized staff and peer recovery specialists and it ensures tailored-patient focused treatment programs to ensure adherence and improve outcomes. While prior authorization has been waived for lower dosages or short-term supplies of drugs used for MAT in many case, medical management is still an important tool to track patient progress and adjust a treatment plan when needed.
More work remains. Only 44% of Medicaid patients under 65 and suffering from opioid use abuse disorder received treatment in 2017, according to the report.
Health insurance providers continue to be on the front lines of the fight against opioid abuse and, recently, AHIP launched its Safe, Transparent Opioid Prescribing (STOP) initiative. The initiative uses the 2016 Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain as a baseline to track progress being made in reducing opioid prescriptions and making sure patients get the care they need. It also fosters increased collaboration among insurance providers and care providers to tackle the epidemic on all fronts –prevention, intervention, and addiction treatment.
More information can be found here: https://www.ahip.org/ahip-stop-initiative/