The heroin and prescription-opioid epidemic are intersecting with the Affordable Care Act and parity, creating new access to treatment. This is an exciting time for opioid treatment programs (OTPs), says Gabrielle de la Gueronniere, national policy director for the Legal Action Center (LAC).
The LAC recently released a report on medication-assisted treatment (MAT), showing that it is the best way to address the opioid epidemic, and focusing on how to eliminate the barriers to such treatment.
LAC’s recommendations to improve access to MAT are:
- Provide meaningful insurance coverage for addiction medications—methadone, buprenorphine, and injectable naltrexone—through all private and public insurance.
- Create new rules governing private insurance and medications.
- Update insurance formulary tiers so all approved addiction medications are covered.
- Reform Medicaid policies that require doctors to pay up-front for the medications they prescribe.
- Enforce public and private insurance consumer protection requirements, including examining the availability of MAT in insurance and Medicaid plans.
- (For the Centers for Medicare and Medicaid Services [CMS]): Issue final regulations on how parity applies to Medicaid coverage (see separate article in this issue).
- Bring insurance plans into compliance swiftly if they are violating the law.
- Educate and train health care providers and criminal justice officials on MAT.
- Provide MAT to individuals involved in the criminal justice system, fully integrating it into jails, prisons, and community-based programs.
- Eliminate drug courts and other programs that restrict access to MAT.
- Focus on treatment and recovery instead of incarceration.
- Enact the Comprehensive Addiction and Recovery Act of 2015 (CARA).
- Expand the Substance Abuse Prevention and Treatment Block Grant, to finance gaps in treatment coverage that will remain even as the Affordable Care Act and the federal parity law are implemented.
The above are all touch points for OTPs, said Ms. de la Gueronniere, who was joined by LAC president and director Paul Samuels in the AATOD presentation in March. The state Medicaid agency, the single state authorities for substance use disorders, the state health insurance board, and community treatment providers need to work closely together. There is a “huge interest by drug courts and other community courts, jails, prisons, and reentry and community supervision programs” in the substance use disorder (SUD) provider network, she said.
Insurance companies are starting to pay attention to the evidence that methadone helps people get into recovery, said Ms. de la Gueronniere in an interview with AT Forum. “There’s still a lot of work to do,” she added. “There’s continued stigma and discrimination around methadone, and lack of understanding of what OTPs do. It’s on us to articulate the value of what they bring, and how our system works.”
Models in which primary care health services and addiction services, including MAT, are integrated, show how effective MAT can be. And while none of this is short-term or immediate, said Ms. de la Gueronniere, stakeholders from all areas are realizing now that the promises of the ACA are being fulfilled. “The ACA is being made more real,” she said. “People are seeing that there is improved coverage and better access to care.”
For the LAC report on MAT, go to http://lac.org/resources/substance-use-resources/medication-assisted-treatment-resources/case-for-eliminating-barriers-to-medication-assisted-treatment-of-heroin-and-opioid-addiction/.
For a joint federal agency informational bulletin on MAT, go to http://medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-11-2014.pdf.