Budget panel considering two-year MaineCare cap for Suboxone


The Portland Press Herald

A state budget-cutting task force is considering a two-year MaineCare limit on some forms of drug addiction treatment.

Officials with MaineCare, the state’s Medicaid program, proposed a cap on coverage of treatment with Suboxone, a replacement drug that helps opiate addicts resist cravings while getting counseling and therapy. Cutting off coverage after two years would save $787,313 in the 2013 budget, the agency says.

Members of the Streamline & Prioritize Core Government Services Task Force have not yet decided whether to add the idea to their final list of proposed cuts. But they suggested during a meeting Friday that the two-year-limit might also be applied to methadone, another replacement drug used to treat addicts. It’s not yet known how much money that limit could save MaineCare.

“When is enough enough? Or is this a lifetime treatment?” said Joseph Bruno, a former legislator and member of the task force.

Physicians who treat addicts said Monday the limit would lead to more addiction at a time when Maine is already dealing with historically high levels of overdoses and drug-related crime.

“There are people who are in constant crises in their lives who will relapse without being on stabilizing medication,” said Dr. Mark Publicker, an addiction specialist at Mercy Recovery Center in Westbrook. “It would be as logical as putting people on type 2 diabetes medication for two years. It’s as much a medical disease.”

The Streamlining Task Force is building a list of $25 million in proposed cuts to give to the Legislature in December. The limit on drug addiction treatments is sure to be among those that generate a backlash if lawmakers formally take them up early next year.

Suboxone and methadone are prescribed to thousands of Mainers fighting addiction to prescription painkillers or heroin. About 15,000 Mainers are receiving methadone or suboxone treatments, and most of them are covered by MaineCare. Two-thirds of the 4,000 Mainers admitted into treatments last year were covered by MaineCare, according to state figures.

The treatments cost about $300 per month for each patient.

Recovering addicts take small daily doses of the drugs to limit cravings as they rebuild their lives and go through therapy. While many are weaned off the medications within two years, others rely on medications to stay sober for many years. It was not clear on Monday how many MaineCare members have gone beyond two years in the treatments.

Jane Hallett of Lubec said she has been taking daily doses of methadone for six years. “You cannot do it within two years. You just can’t,” she said.

The 50-year-old said she is gradually reducing the dose, but is sure she would relapse without the treatment.

“I have severe depression,” Hallett said. “And when things aren’t going right … my answer is to go get a pill. And still, after six years (on methadone), the urge is still there once in a while.”

The two-year cap is based on federal guidance and on established best practices, according to a statement provided by the Office of MaineCare Services. The agency also said it plans to allow members to exceed the two year limit if it is medically necessary and the provider gets prior authorization for the treatment.

Bruno, the task force member, said the cost has become too great for the state and some treatment providers are profiting from the long-term use of the drugs. Some patients are profiting, too, by selling their medications to other users and addicts, he said.

“If people are productive and they’re doing well on the stuff, it’s a hard call. But there are some people who aren’t productive and it’s becoming a profit center for them,” Bruno said. “It’s a fine line, but how much are we willing to pay for?”

Publicker and other doctors say there is no standard time of treatment for a recovering addict. “It requires a combination of medication and lifestyle changes,” he said.

Publicker said he is treating a young mother who has been on suboxone for two years, has paralyzing depression and is on the verge of being homeless. Suboxone is the only thing keeping her from abusing painkillers again, he said.

“If I say ‘Oh, by the way, your two years are up,’ I would have a dead patient,” he said.

Dr. Joseph Py, corporate medical director for the Discovery House methadone clinics in Maine and several other states, said he knows of no states with time limits on the treatments.

“There’s nothing in the addiction medicine literature that has been written that could justify a two-year limit,” he said. “Continued open-ended treatment is the medical standard of care.”

An arbitrary limit will push more people back into addiction, eventually costing the state much more in additional emergency room visits, crime and fatal overdoses.

“There’s a 10 percent mortality rate per year for individuals who leave methadone replacement treatment before they’re ready,” he said.

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