Coventry violates state contract by not covering drug

Coventry Care, a Medicaid managed care insurer in Kentucky, said it will stop covering an expensive medication that helps treat drug addictions. The state, however, condemned the decision as a contract violation.

Coventry will begin denying coverage for the narcotic drug buprenorphine, which eases patients' addictions to common painkillers, for patients being treated in a network of addiction clinics called SelfRind. The Medicaid insurer said it will continue covering the drug for existing patients and will allow 15-day extensions for patients with authorizations expiring in the next week, reported the Courier-Journal.

However, Kentucky's Cabinet for Health and Family Services said Thursday that Coventry's decision violates its contract with the state, the Lexington Herald-Leader reported. "The cabinet believes that Coventry cannot take this unilateral action without the cabinet's approval and, in doing so, is in violation of its contract," Cabinet spokeswoman Jill Midkiff said in the article. "The cabinet will be sending a letter to Coventry to that effect."

Coventry said it's decision is based on cabinet policy, which only requires Kentucky's Medicaid program to cover buprenorphine for pregnant women, women who recently gave birth and those under age 21, noted the Herald-Leader.

"Until very recently, Coventry has been covering substance abuse replacement therapy for all members," said Coventry spokesman Matt Eyles. "What we've done is align our coverage with the cabinet's Medicaid policy." He added that Coventry has developed a care transition policy.

SelfRind asked the cabinet to intervene and said it might file suit to seek a court injunction against Coventry. Midkiff said the cabinet will send a formal letter of rebuke and will look into further action if Coventry doesn't respond, according to the Associated Press.

To learn more:
- read the Lexington Herald-Leader article
- see the Associated Press article
- check out the Courier-Journal article