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Lawmakers Consider Limiting Coverage For Methadone
03/07/2014   Reported By: Susan Sharon

Less than a year after the Maine Legislature rejected bills that would have either eliminated or further restricted Medicaid coverage for methadone and Suboxone treatment, lawmakers are considering additional limits once again.

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Currently, the state has a 24-month cap on Medicaid coverage for both medications, which are considered the most effective ways to treat opiate addiction. As Susan Sharon reports, a new proposal would limit coverage to six months, at which time a patient would need special approval to continue treatment.

When it comes to methadone and Suboxone, Dr. Joseph Py said the medical literature is clear: treatment should be open-ended. That's because opiate addiction rewires the brain. PY said Methadone and Suboxone act as opiate replacement therapies that stabilize brain function and allow patients to ENGAGE IN counseling and other services and begin to recover. Py said those who stop the medication TOO SOON don't fare very well.

"In fact, there's a ten percent per year mortality with people who prematurely, let's say they were in methadone treatment already, they prematurely stop it," Py said. "There's a ten percent mortality rate associated with that. So, you do the arithmetic and in ten years there's a hundred percent."

Py is an addiction specialist who serves as the corporate medical director for Discovery House, which operates 18 methadone clinics in four states, including two clinics in Maine. He said some patients can stay on methdone for 25 years or longer. Those who drop out at two or three years or less will often relapse and return. And that's exactly why Lisa Harvey-McPherson said setting a six-month limit is a bad idea. McPherson was speaking on behalf of Acadia Hospital in Bangor and the Mercy Recovery Center in Westbrook.

"Acadia ran a 180-day treatment program on methadone," said McPherson. "And what's interesting, when we did that, 100 percent of the patients relapsed because we tried to taper their methadone down toward the end of the program and it failed."

Both McPherson and Py appeared in front of the Legislature's Appropriations Committee Thursday afternoon to argue against the proposed six-month cap, being considered by the panel as part of the supplemental budget. As of January 1st, more than 4800 people were enrolled in methadone treatment at one of 11 clinics in Maine. According to the Maine Department of Health and Human Services, more than half of them were Medicaid patients. The state spends more than nine million dollars on their treatment and more than seven million transporting them to clinics. It's unclear how much money the six-month limit would save the state. But cutting back Medicaid coverage for methadone and Suboxone is not uncommon. A recent report by the American Society of Addiction Medicine found that more than half the states provide it but coverage varies. And most states require prior authorization or special approval for Suboxone. If Maine goes that route, Dr. Py said that will just create more work for providers.

"It's like saying, Your doctor diagnoses you with sinusitis and said, You need two weeks of antibiotics. She writes the script and you go to the pharmacy and the pharmacist said, Here's your two pills, this is all we can pay for. And then you have to get your doctor to send in another form and so you're gonna have to come back and so over the span of two weeks you're gonna have to come back seven times."

Unlike previous proposals to limit Medicaid coverage for substance abuse treatment, the LePage Administration is not backing the latest plan. And despite Maine's chronic opiate addiction problem and a recent spike in heroin deaths, Gov. Paul LePage said he'd like to see methadone treatment move from free-standing, for-profit clinics to doctors' offices and hospitals.

"Because we have evidence that much of the methadone that's being distributed is finding its way onto the streets," said LePage. "That's what we're trying to avoid...The whole issue is the methadone clinics, many of 'em don't have adequate clinical oversight."

Dr. Py points out that methadone treatment is regulated by five state and federal agencies including the U.S. Drug Enforcement Administration. And he said he's not aware of any Maine hospitals that want to take on methadone patients especially since the state's Medicaid reimbursement rate continues to decline.

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