April 1st, 2015

Insurance coverage of methadone for treatment to expand

The Massachusetts Association of Health Plans or MAHP announced in February that its 17 member health plans – which cover 2.6 million residents in the state – will cover the medication assisted treatment in “an effort to enhance access to services to treat opioid addiction that are evidence based and promote clinically appropriate care,” according to a news release.

“Given the data and evidence about the effectiveness of methadone treatment, plans have looked at that research and changed their plans accordingly,” said Eric Linzer, a spokesman for the MAHP.

The change, which will happen by July 1, comes following discussions by state lawmakers and officials on how to address “the growing statewide epidemic,” said the release.

“Like many states across the country, Massachusetts is facing an epidemic of opioid and heroin addiction and overdose deaths,” said Scott Zoback, a spokesman for state’s Executive Office of Health and Human Services. “We need to address this crisis using every resource at our disposal across four key areas: prevention, intervention, treatment and recovery support.”

There were 868 confirmed deaths from addiction to prescription painkillers and heroin in Massachusetts in 2013, according to the office. There were 668 confirmed overdose deaths in 2012 and 603 in 2011.

Methadone has not typically been available as part of commercial coverage for maintenance treatment, according to the release. Some members of the MAHP such as Medicaid Managed Care Organizations have covered methadone in the past.

Linzer said the medication has typically been purchased by Massachusetts in bulk and made available through state addiction programs and clinics.

This change is “another tool in the toolbox for patients, families and providers for patients suffering with opioid addiction,” Linzer said.

Harvard Pilgrim HealthCare, a member of MAHP, has typically covered methadone when delivered as an inpatient detoxification treatment, said Joel Rubinstein, M.D., medical director of behavioral health for the health benefits company. That will change with this expansion.

“Medication assisted treatment, when coupled with psychosocial therapy, is among the most effective treatments for opiate addiction, particularly with those who don’t have other complicating health conditions or issues,” Rubinstein said. “In addition to methadone, there are a number of medications that are highly effective, such as buprenorphine (suboxone) and vivitrol (naltrexone) and Harvard Pilgrim covers them as well.”

CeltiCare Health Plan of Massachusetts Inc., another member of MAHP, said the change is an important step for the managed care organization.

“We have been committed to fighting opioid addiction in the Commonwealth for many years now and are proud to continue our commitment to our members,” said Robert LoNigro, M.D., chief medical director for the New England region of CeltiCare Health and New Hampshire Healthy Families. “Since CeltiCare Health’s entrance into the marketplace in 2009, we have provided our members with all of the resources appropriate for the treatment of substance use disorders.”

According to the MAHP, members provide coverage for a broad range of services to treat opioid addiction, using nationally based guidelines from the American Society of Addiction Medicine.

By Rivkela Brodsky

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