Patients on Medicaid still face a host of barriers to accessing medication-assisted treatment (MAT), a panel of experts told the Medicaid and CHIP Payment and Access Commission (MACPAC) on Friday.
Barriers blocking access to MAT for patients on Medicaid include everything from limits placed on doctors for prescribing MAT drugs because they can be diverted for misuse and illicit use, as well as long wait times for prescriber appointments and cash-only clinics, the experts told MACPAC, which is charged with advising Congress on Medicaid programs.
Other problems include gaps in treatment between coverage transitions and emergency departments that are not regularly staffed with buprenorphine prescribers and are not able to help patients presenting for treatment, said Kristin Hoover, who is the clinical pharmacy manager for the Pennsylvania Department of Human Services Office of Medical Assistance Programs.
"It is unfortunate that it is easier for prescribers to write prescriptions for opioids than it is for prescribers to write prescriptions for buprenorphine MAT," Hoover said.
"The problems with prior auths translate into problems for the patient and for the practices and become real barriers to care, especially in some required counseling. We've had that be an issue where there's a prior auth to a particular counselor, that counselor is not available and then there is a whole breakdown in the system," Carter said. "We have to balance all of these requirements with 'How is it going to affect the patient and the practice that has to track all of this?'"
She also pointed to poor collaboration with the criminal justice system including parole boards, drug courts and police as hurdles.
"I know that's beyond the scope of this commission," Carter said. "I had a conversation with someone from a parole board who told me if a person on parole came in on buprenorphine, that was considered breaking parole. We have a long way to go in public understanding."