December 28, 2012

Two-year MaineCare cutoff for opiate addiction drugs kicks in Tuesday

Patients on Suboxone will need to prove the drug works to continue receiving it; those prescribed Methadone face a two-year time limit starting on Tuesday

BY WANDA CURTIS, Correspondent

Health officials say those who still need certain drugs to treat addiction won't be cut off entirely, even as a legislative bill aims to cut off treatment for some.

click image to enlarge

Michelle Morin, a registered nurse at Merrimack River Medical Services in Portland, administers Methadone at a dosing window on Jan. 9, 2008.

Portland Press Herald file photo by Jack Milton

MaineCare coverage for Methadone and Suboxone is set to cease on Tuesday for treatment for those who have been covered for at least 24 months. A bill passed by the Maine Legislature established the 24 month lifetime limit.

But a task force of medical providers, substance abuse treatment providers, government officials, and patient advocates have developed criteria for continued MaineCare coverage of medically necessary Methadone and Suboxone treatments.

The actions of the task force may have averted what was predicted to become an unprecedented drug withdrawal crisis in January. Methadone and Suboxone are used to treat opiate addictions.

The medical director of MaineCare Services, Kevin Flanigan, said that the task developed guidelines for continued MaineCare coverage of those treatments for those who need it. He said that Suboxone funding will cease as of Tuesday for people who have reached the two-year coverage limit -- the 24 months don't need to be consecutive -- only if medical providers are unable to get authorization to continue the treatment before the deadline.

Flanigan said the task force has identified specific behavior that may help indicate whether Suboxone treatment has been successful. He said that people reviewing authorization applications will ask questions about clients such as:

* Have they been able to reunite with their families?

* Have they been able to return to work?

* Have they been able to engage in social or community or recreational activities again?

* Is there a spiritual component to their life that was absent before?

* Are they no longer having difficulties with the legal system?

* Are they engaged in constructive activities their provider has asked them to participate in?

Flanigan explained that providers will also be asked whether the client is receiving the lowest optimal dose, when determining whether Suboxone treatment has been effective for them. He said that if the provider says the person relapsed every time weaning was attempted, then treatment hasn't been successful and the provider should discuss other options.

Flanigan said that if Suboxone treatment has been deemed successful and if it's determined to be medically necessary, coverage for the treatment will be approved for six month increments, and the provider will be required to reapply every six months.

Flanigan added that if a client is denied, the provider can reapply after the client is given another opportunity to meet the criteria.

Flanigan said that no one would be required to discontinue Suboxone treatment cold turkey if the patient's MaineCare funding is denied. He said the patient would be allowed a three-month tapering period during which treatment would still be funded.

Flanigan said members who will reach the 24 month coverage limit in January should contact their medical provider immediately to determine whether the provider applied for authorization or whether the client must seek another payment source.

For Methadone coverage, Flanigan said that the two-year countdown for that drug begins Jan. 1 -- Tuesday. Unlike the new rules for Suboxone treatment, it's not retroactive.

He said that countdown starts "whether it's their first day of treatment or the first day of their ninth year of treatment."

Both of those funding decreases, which are part of overall state budget cuts, come at a time when Maine reports the highest per capita rate of people seeking treatment for opiate addiction in the country.

Roy Miller, a physician who practices at Sheepscot Valley Health Center in Coopers Mills, said providers are re-examining their narcotic prescribing practices because they've been warned that narcotics have been overprescribed in the past.

"So we're cutting back," Miller said.

Miller said that the limit was established because of financial constraints, not because two years was proven to be the optimal time to discontinue treatment. He said that some addiction specialists suggest teenagers who become addicted to certain drugs may need lifelong treatment because the drugs affect their brain while it's still growing.

Miller said the length of time needed for treatment to be effective varies from client to client.

Miller is one of a handful of Maine health care providers prescribing Suboxone in a private office setting. Those providers enroll in specialized training to qualify to treat with Suboxone.

Miller said that Suboxone is expensive -- $7 to $8 per pill -- but it allows people with opiate addictions to live more normal lives because they don't have to travel to a Methadone clinic daily for treatment. There is a generic medication that costs less but doesn't produce the same results, he said.

Miller said Suboxone has been effective with patients he's treated over the last four years. "When they first come in, they're climbing the walls," said Miller. "After they've received treatment, many of them are able to hold jobs and get their families back together. Many say that before they spent their whole day getting money and getting drugs. Now they're getting their kids back."

Alane O'Connor, a nurse practitioner who holds a doctorate, prescribes Suboxone at Maine Dartmouth Family Practice in Fairfield. She said patients are able to use the medication to reduce the craving and withdrawal symptoms associated with opiod dependence.

"These patients are participating in substance abuse counseling to learn healthier ways to cope with stress and other triggers with the goal of fewer opiod relapses in the future," she said.

O'Connor was on the task force that developed the Suboxone authorization guidelines.

She said she was pleased overall with what they were able to accomplish given the limitations of the legislation, but she's concerned the need for additional paperwork may hinder some from getting the medication in a timely fashion.

"We all know that we have an opioid abuse epidemic in Maine and implementing barriers to treatment is not going to help the problem," O'Connor said.

She said that many of her clients have been able to "re-engage with their children and families, re-enter the work force, complete their GED, or even enroll in college."

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