Tennessee's Medicaid program is trying to make it easier for patients to get prescription drugs that help treat opioid addiction. The moves come after years of restricting access to the medication because of concerns about abuse and diversion.
"The number of prescriptions for TennCare enfrollees has grown substantially over time," states the prescribing manual from 2014. "This significant growth demonstrates the need for explicit control on use of the drug."
TennCare is striking a different tone now.
Doctors need a federal waiver to prescribe buprenorphine, which eases the cravings for opioids and withdrawal symptoms. Tennessee doesn't have nearly as many waivered physicians as some states, so TennCare is encouraging doctors to consider it and assembling a list of providers who are up to the state's standards.
The Medicaid agency is also streamlining the prior authorization process to prescribe buprenorphine and by January 1 will offer more generic forms after scaling back to primarily covering Bunavail in recent years.
"We are in a place now in our state where we have to rethink everything that we're doing, given how challenging the opioid epidemic is," says TennCare chief medical officer Victor Wu.
The current science indicates that medication-assisted treatment helps, Wu says. And TennCare's own data shows that of its nearly 25,000 patients with diagnosed opioid use disorder, those on buprenorphine and receiving appropriate counseling end up saving taxpayers. That's because they're less likely to seek out phony prescriptions or overdose.
"We need to get those individuals out of using the ER, out of using the hospital for a lot of services that aren't even treating their addiction," Wu says.
According to the National Institute on Drug Abuse, every dollar spent on evidence-based treatment cuts health care and criminal justice costs by up to $12.