Medication Assisted Treatment and Policy

Getting The Job Done Despite A Patchwork of State and
Federal Opioid Treatment Policies

Medication Assisted Treatment (MAT) is gathering tremendous momentum–quickly. In combination with counseling and behavioral therapies, MAT is offering hope as an effective strategy to treat SUD and prevent relapse, or worse, overdose. Accredited OTPs (Opioid Treatment Programs) utilizing MAT, are currently exploding in number and popularity, and are expected to grow in the future to serve the unfortunate need for opioid dependence treatment. It may be the only solution.

The FDA has recently approved a number of new opioid dependence treatment options, including Buprenorphine, Naloxone and Vivitrol. As a result, Medicaid unit payments for medication assisted treatment for addiction disorder increased by 183% between 2011 and 2017, with 26 states covering MAT for opioid addiction. And there is no doubt that the opioid crisis we are experiencing in this country will convince more states to expand coverage for, and access to, MAT. Along with telehealth and expanded Medicaid prescriber capabilities (allowing for more immediate access to treatment to either prevent a person from experiencing a high from opioids, or block the effects of withdrawal), MAT could prove to be a lifeline for those in the grips of opioid addiction. Let’s hope so.

The Case For MAT
Going back to 2013, estimates put the number of opioid use disorder cases at 1.8 million, mostly related to prescription pain relievers, and approximately 500,000 individuals suffered from an opioid disorder related to heroin use. For these groups, MAT has been clinically proven to significantly reduce the need for inpatient services. MAT delivers a more comprehensive, individually tailored program, with support services. At the end of the day, MAT can:

  • Improve patient survival

  • Increase retention in treatment

  • Decrease illicit opiate use and other criminal activity among people with substance use disorders

  • Increase patients’ ability to gain and maintain employment

  • Improve birth outcomes among women who have substance use disorders and are pregnant

The Feds and The States: Scrambling for Solutions.
The United States Congress has stepped up to the tune of $3.3 billion in funding, and the President has launched a host of new initiatives. They’ve made a bold statement: our goal is to address the growing problem of opioid dependence and drug-related mortality rates. But it is the individual states, those on the front lines, who will have perhaps the greatest impact on the problem. And for many states, navigating around and through Federal policies to serve the specific needs of their states can be daunting.

In Pennsylvania, Governor Tom Wolf announced that his state’s Medicaid program would waive prior authorization requirements for MAT. In addition, The UMPC Center For High Value Care awarded $5.7 Million to expand access to MAT in four Pennsylvania counties.

In West Virginia, Medicaid has expanded state addiction treatment coverage to include MAT.

In Maryland, The Maryland Health Care Commission (MHCC) is attempting to “optimize” its MAT program by using advanced Telehealth services. Telehealth will assist licensed health care practitioners in providing patients MAT with buprenorphine remotely.

In Ohio a newly expanded opioid treatment program includes buprenorphine along with injectable, nasal, and oral naltrexone; medication administration, and collection of blood samples for external laboratory testing.
In New Jersey, The New Jersey Department of Human Services will launch a performance-based, enhanced care management program for opioid disorders, at a cost of $30 million.
And in Wisconsin, Governor Scott Walker famously signed 11 bills into law related to the state’s Heroin, Opiate, Prevention and Education (HOPE) strategy.

More MAT On The Way
We’re seeing more of these developments coming soon. Last month, the FDA announced new guidelines intended to help with the development of new MAT medications for opioid treatment
As Congress races to pass laws, and states rush to institute policies to deal with the burgeoning problem of opioid addiction, it is encouraging that the hesitancy to address addiction has seemed to have lifted. We’re seeing concern expand at a rapid pace—from new benefits, like MAT; to new programs, like opioid health homes and care management programs; to new service delivery options, like telehealth.

The opioid crisis is accelerating the acceptance of MAT for addiction treatment. Over the past few years, we’ve seen a steadily increasing acceptance of MAT, but there are remaining policy barriers and regulatory hurdles.

What Does MAT Mean for Health Plans?
This MAT fast-lane presents health plans and provider organizations with a fundamental challenge—with new medications and new treatment technology, what is best practice and how to decide? We urge Congress and state officials to work together more closely to provide funding and expertise in the battle against the horrible prison of opioid addiction.