December 28, 2012

Some MaineCare patients will still have access to methadone

A task force developed criteria for continued MaineCare coverage of certain drug treatments.

By WANDA CURTIS Kennebec Journal Correspondent

Health officials say Mainers who need certain drugs to treat addiction won't be cut off entirely, despite legislation to cut off treatment for some.

MaineCare coverage for treatment with methadone and Suboxone is due to end Tuesday for those who have been covered for at least 24 months. A bill passed by the Legislature established the 24-month lifetime limit.

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

That may avert what was predicted to become an unprecedented drug withdrawal crisis in January. Methadone and Suboxone are used to treat opiate addiction.

The medical director of MaineCare services, Kevin Flanigan, said the task force developed guidelines for continued coverage for people who need the treatment. He said Suboxone funding will end Jan. 1 for people who have reached the two-year 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 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 in constructive activities their provider has asked them to participate in?

Flanigan said providers will also be asked whether a client is receiving the lowest optimal dose, in 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 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 said that if a client is denied, the provider can reapply after the client is given another opportunity to meet the criteria.

Flanigan said no one would be required to discontinue Suboxone treatment cold turkey if 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 people who will reach the 24-month coverage limit in January should contact their medical providers immediately to determine whether the provider applied for authorization or whether the client must seek another payment source.

For methadone coverage, Flanigan said the two-year countdown begins Jan. 1.

Unlike the new rules for Suboxone treatment, it's not retroactive.

He said that count 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 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 prescribing practices because they've been warned that narcotics have been overprescribed in the past.

"We're cutting back," he said.

Miller said the limit was established because of financial constraints, not because two years was proven to be the optimal time to discontinue treatment.

He said some addiction specialists suggest teenagers who get addicted to certain drugs may need lifelong treatment because the drugs affect their brains.

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

Miller said Suboxone is expensive -- $7 to $8 per pill -- but it allows people with opiate addiction to live more normal lives because they don't have to travel to a methadone clinic daily for treatment.

A generic medication 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.

"After they've received treatment, many of them are able to hold jobs and get their families back together," he said.

 

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