Join the Fight Against Medicaid Buprenorphine Limitations

Does your state Medicaid program limit the use of buprenorphine and other opiate agonists in addiction treatment? If it doesn’t, it soon will—unless addiction medicine specialists lead the battle to maintain the availability of medical treatment.

Mark Publicker, M.D., FASAM, President of the Northern New England Society of Addiction Medicine, will discuss the limitations proposed in Maine and other states during Component Session 5, “State Medicaid Limitations on Buprenorphine: How to Fight Back.” The session runs from 10 a.m. to noon, today in Grand Salon West, Salon E.

Patients in Maine are already facing an abrupt cutoff in medication after a maximum of two years of treatment, Dr. Publicker cautions. The new Medicaid limitation is retroactive, which means patients on long-term therapy will be hit first and hardest.

“There is absolutely no clinical intent in imposing these limitations,” Dr. Publicker says. “There were no medical professionals involved in making the decisions to set this limitation. Nor were policy makers interested in copious information regarding the clinical disease and the clinical requirements for treating opiate addiction. This is completely, solely, and openly a fiscal policy to save money. No other chronic illnesses are being so targeted.”

Addiction treatment is a prime target, he says. Patients with addictive disorders are widely disliked and feared. That makes them vulnerable ideologically. And they are both small in number and politically unorganized, which makes them an easy target politically.

“Opiate addiction is a chronic brain disease,” Dr. Publicker says. “As with all chronic illnesses, it requires chronic therapy. There cannot be arbitrary limits on treatments. We know that for significant opiate addiction, long-term opiate agonist therapy with medications, such as buprenorphine and methadone, are necessary to sustain a robust recovery.”

Clinical arguments against treatment limitations are needed, he says, but carry little weight in the current economic climate. Economic arguments also are needed but should not carry too much weight.

“We can clearly demonstrate a seven-to-one benefit ratio for every dollar spent on treatment in terms of dollar savings in decreased crime and savings in decreased illnesses such as HIV, hepatitis C, and premature birth,” Dr. Publicker says. “What I have learned in this fight is that all that really matters is what is happening in the current fiscal year. It is a silo effect, and it is a political effect. The Department of Health and Human Services has different priorities than the criminal justice side has. And whoever has a closer ear to the governor wins.”

Addiction specialists in Maine joined with three other organizations to fight proposed Medicaid changes. They lost.

“It is a horrible situation,” Dr. Publicker says. “These Medicaid limitations condemn our patients to withdrawal and to the specter of active addiction.”

What budget officials in Maine see as a successful effort to cut Medicaid dollars is spreading to other states, according to the National Buprenorphine Treatment Network. In some states, buprenorphine/naloxone and other opiate agonists may not be covered for addiction treatment. Other states are imposing prescribing and refill limits.

“The fight against these limitations is just beginning,” Dr. Publicker says. “The purpose of this workshop is to provide ASAM members with information that limitations are coming and how we can develop strategies to fight back.

“The fight against limitations requires coalitions. It requires a comprehensive approach involving organizational support and cooperation, effective lobbying, developing personal relationships with legislators and the executive branch, and public information involving the media. It is important to make the clinical case and the economic case against limitations. It is just as important to take this issue to the public, to enlist patients, patients’ families, and other advocacy organizations to join in the fight. We, ASAM, are the voice of advocacy for our patients. We want ASAM members to march out of this workshop prepared to join the good fight.”