Bicycle Health, a virtual provider of opioid use disorder (OUD) treatment, is launching a program for teens in the state of Maine.
The company says this is the first program of its kind in the country. Patients 16 and 17 years of age will be eligible for medications for opioid use disorder (MOUD) via telehealth under the model. In 2019, 12% of Maine high school students reported (PDF) having misused prescription pain medications.
This will be the first time Bicycle is treating teens. The company decided to stand the offering up after hearing directly from one of its payer partners, whose name was not disclosed, that there is a big need among its network of providers to have a partner to refer teens with OUD for care.
“From the payer side, the concern was all around not having any access to care whatsoever,” Brian Clear, M.D., Bicycle's chief medical officer, told Fierce Healthcare.
While the state does not require parental consent for treatment, Bicycle Health’s program requires a parent or guardian to attend the teen’s first visit to ensure they are informed about their treatment.
“Because opioid use disorder is still such a stigmatized disorder… it was important that we considered the impact on parents and tried our best to at least in good faith try to get parental consent,” Clear explained.
Even if a parent ultimately does not want their teen to get treated, as long as the patient consents, the program can move forward. The patient also has the option of getting the treatment confidentially after the first visit. If a parent refuses to attend the first visit, a physician can determine on a case-by-case basis the best way to possibly move forward with treatment.
When it comes to treating anyone with OUD, what determines success in recovery is an early intervention and starting with effective treatment right away, Clear said. But teens often initially start with a nonmedical form of support, such as an abstinence-based program. These models have nearly 100% relapse rates, Clear noted. By contrast, 60% of Bicycle patients are still in treatment within a year of starting. Non-medication-based treatments also significantly raise the risk of death compared to no treatment at all.
“There’s nothing particularly magical or innovative about our approach, it’s just to deliver the right recommended treatment at the right time,” Clear said. MOUD has been proven to cut the risk of overdose in half.
As part of the latest program, patients are required to engage with Bicycle’s support groups and recovery coaches. Bicycle providers also treat co-occurring health conditions, including depression and anxiety. While they don’t offer therapy, they take a therapeutic approach known as motivational enhancement in each visit. For those who would benefit from psychotherapy, they refer to outside providers. Though Bicycle has employed psychotherapists in the past, demand was not strong, Clear said. The company is still figuring out how to best engage patients in that offering.
The teen program is available with insurance and cash. The company is in-network with the state’s Medicaid plan, MaineCare, as well as private payers in the region. Its self-pay option is priced at $199 per month. Clear expects most teens in the program to be covered under Medicaid.
When it comes to MOUD, Bicycle relies on buprenorphine and its injectable form sublocade, plus naltrexone. Since it is not an opioid treatment program, it cannot prescribe methadone. The American Academy of Pediatrics recommends medications for the treatment of teens with severe OUD.
As a first line of treatment, buprenorphine is comparably effective to methadone, per Clear. Naltrexone, by contrast, is much less effective than either. For those few for whom it is not effective, methadone would be the next step. Still, Bicycle refers patients to an opioid treatment program very rarely, Clear said. Most patients who leave the program do so because of financial reasons like a change in insurance or for another provider, he added.
While there are no major differences in treating teens and adults with OUD, the biggest task the company undertook to launch the program was legal and compliance review. According to Clear, most providers are afraid to treat teens with OUD because they are not a particularly profitable population and the perceived risk of noncompliance.
“This isn’t an expansion for the sake of profit,” Clear noted. “It’s a population that’s in need … we can do it, so we choose to do it.”
Bicycle went through an intense review process and heard varying opinions from experts even within the state, many of whom believed that parental consent was required. “The default answer before you do any research seems to be yes, it is required,” Clear said.
The company doesn’t expect the teen program in Maine to exceed around two patients a month. One physician will be taking on all the company’s teen patients in the state until demand grows. The company does hope to expand to other states as regulations allow.
Editor's Note: This story was corrected to reflect that Bicycle Health's self-pay option is priced at $199, not $139, per month. It was also corrected to state that while buprenorphine is comparably effective to methadone as a first-line treatment, naltrexone is not.