Kentucky has the third highest rate in the country for Medicaid prescriptions of buprenorphine, a drug that helps treat people with an addiction to opioids.
A study released last week by the Urban Institute shows that in 2018, Kentucky Medicaid enrollees filled 659,629 prescriptions for buprenorphine. That averages out to about 662 prescriptions per 1,000 enrollees ages 12 and older.
“Kentucky expanded Medicaid early on, which is likely a key reason that treatment using buprenorphine prescriptions is fairly high in Kentucky,” said Lisa Clemans-Cope, the study’s lead author.
“In a lot of states that didn't expand Medicaid, there are people with opioid use disorder that really do not have access to affordable treatment,” she said. “In Kentucky there’s this Medicaid safety net that really provides effective care for the people who need it.”
Vermont led the nation in the rate of buprenorphine prescriptions, with West Virginia following. Both of those states have expanded Medicaid.
Florida — which did not expand Medicaid — had the fourth lowest rate nationwide and also has an opioid-related overdose death rate higher than the national average. Texas, which also didn’t expand Medicaid, came in second to last, with 8.4 prescriptions per 1,000 people in 2018.
Gerard Vitti, founder and CEO of benefits technology firm Healthcare Financial, Inc., says the study shows that access to health insurance does lead to higher numbers of people getting treatment. With Gov. Matt Bevin working toward making changes to the Medicaid program for some enrollees, access to this treatment could change in the future. The proposed changes include things like copays and work requirements.
"Kentucky is a leader in use of this therapy presently because it expanded access to Medicaid,” Vitti said. “For the future, the important question is the number of people covered by the program. If the caseload decreases, then the state’s utilization of this therapy could decrease."
Buprenorphine is used to reduce cravings among people who are going through withdrawal from opioids. It can also be used as a long-term maintenance drug. Other drugs like methadone and naltrexone can be used similarly in addiction treatment, but the study focused only on buprenorphine.
Amanda Newton worked at Centerstone, a nonprofit mental health and addiction provider, when it started offering buprenorphine. Newton said before the facility started prescribing buprenorphine, patients’ physical withdrawal symptoms sometimes led to relapse. “They were leaving against medical advice and going out and using,” she said.
Then, Centerstone started using buprenorphine to treat initial withdrawal symptoms.
“After that, we started seeing an increase in people staying in treatment,” Newton said. “Prior, most of all our treatment was 12-step, abstinence based.”
After that success in short-term buprenorphine use, Centerstone started using the drug for long-term treatment of opioid addictions.
Removing More Barriers To Access
Lisa Clemans-Cope at the Urban Institute said there’s still work Kentucky could do to make buprenorphine more accessible. For example, in Vermont, state officials have removed all prior authorization requirements for the drug.
This year, the Kentucky Cabinet for Health and Family Services removed prior authorization for one type of buprenorphine combined with naloxone, which is a drug that reverses an opioid overdose. But Kentucky Medicaid still has prior authorization requirements for buprenorphine on its own, including in patch form and ingestible film form.
Amanda Newton is now the chief operating officer at addiction treatment provider Renew Recovery. She said prior authorization requirements can be a huge barrier for someone who’s looking for immediate help.
“What happens is, somebody could want to get engaged in treatment, and sometimes a prior authorization could take an hour, few hours, days, weeks,” Newton said. “And we knew we had to strike when the iron is hot — when someone comes in we need to be able to treat them then.”
