All states have Medicaid plans that are covering some drugs used in medication assisted treatment (MAT), according to a draft report from the Substance Abuse and Mental Health Services Administration (SAMHSA) and Truven Health Analytics.
SAMHSA shared highlights of the report, which is not yet publically available, during a webinar last week that also focused on innovative state practices in the area of MAT.
According to the preliminary results of the report, states are offering coverage of drugs used to treat alcohol use disorder and opioid use disorder. A few states don't cover acamprosate or disulfiram for alcohol use treatment, and few cover extended release-naltrexone. However, coverage of other medications is widespread.
Methadone is another story: It does not appear to be covered in as many as 18 states.
"State Medicaid plans cover all other SUD medications in some form, and in every state, some form of naloxone is reimbursed," says Peggy O’Brien, PhD, JD, a senior research Leader at Truven Health Analytics and the lead author of the updated MAT report.
The report, which is designed to be an update of the 2014 Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders report, included data from all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands.
Preferred status drugs
Researchers also looked at which medications were given preferred status and found the combination of buprenorphine and naloxone earned preferred status most frequently—in 47 states. In addition, oral naltrexone had preferred status in 44 programs, and naloxone was given preferred status in 45. The extended release injectable form of naltrexone had preferred status in just 23 states, primarily because of its high cost, O'Brien said.
Prior authorization is also more common for buprenorphine-naloxone (49 programs), buprenorphine (46 programs), and naloxone (36 programs) than it is for medications such as acamprosate (10 programs), oral naltrexone (10 programs) or disulfiram (three programs).
While coverage of MAT drugs is common, significant barriers still remain to getting patients the treatment they need.
According to Colleen LaBelle, MSN, RN-BC, CARN, director of office-based addiction training and technical assistance and of the opioid addiction treatment extension for community healthcare outcomes model at Boston Medical Center, one of the biggest barriers is the number of physicians who are willing and able to prescribe buprenorphine.
She pointed to data from SAMHSA that indicates that fewer than 40,000 prescribers are currently waivered to prescribe buprenorphine, and the majority of those, or just under 25,000, are at the lowest limit of 30 patients.
Previous research has found that barriers to office based buprenorphine prescribing include insufficient nursing, payment issues and insufficient staff, among others.
At Boston Medical Center, clinicians implemented a collaborative care model that focuses care around the patient and uses the nurses as the primary focal point to assist with patient communication, follow-up visits, intakes, screenings and assessments and other tasks and pools all that information together.
"By the time they saw the prescriber, all those pieces were there, and it made things a lot more simple," LaBelle said.
A five-year study of the model found that opioid addicted patients had outcomes comparable to physician centered approaches, however, the model allowed for more efficient use of the physician's time.
Use of telehealth
In the state of Washington, expanded Medicaid coverage created a greater demand for services. According to Molly Carney, PhD, MBA, executive director of Evergreen Treatment Services in Washington state, some patients were traveling up to three or four hours per day to receive medication through MAT or were on waitlists at opioid treatment programs that could be as long as one-year.
To address the growing need, Evergreen Treatment Services piloted a telehealth program that uses on-site nurse care manager and an off-site physician or prescriber who is able to sit at a computer at another location and write the buprenorphine prescriptions.
At the one-year mark of the pilot, Carney said they saw retention rates in the 70% to 80% range, along with significant reductions in self-reported opioid use and self-reported average days of drug use.
The pilot, which includes two rural locations in Washington run by Evergreen, has also allowed the treatment services center provide care in areas they were never able to reach before.
Jill Sederstrom is a freelance writer based in Kansas City