Collaborating On Buprenorphine

At a time when divisiveness is all too common, I’ve just had an experience that reminded me how groups working together can benefit patients, providers, and payers. On March 2nd, I testified before the Health and Government Operations Committee of the Maryland Legislature in support of House Bill 887. The bill would prohibit insurance companies from requiring prior authorization before a patient can be prescribed buprenorphine. This medication, when used properly, has significantly improved treatment outcomes and reduced overdose deaths in cases of addiction to heroin and other opioids.

This was the first time that I was presenting testimony to a committee of the state Legislature, and I had to spend the better part of the day in Annapolis waiting for our bill to have its turn. I was willing to spend the time because I’ve been working on this issue for over three years, and I thought there was finally a chance to make a change.

I told the Committee that what might seem like a trivial administrative requirement can seriously impede treatment and be life-threatening. For buprenorphine to work, the patient must arrive for treatment in a state of withdrawal. Any delay in providing relief of withdrawal symptoms, such as a prior authorization that can take days to obtain, decreases the chance that the patient will cooperate with treatment. For those interested, the full testimony is available.

Addiction treatment providers had initiated the bill. Delegate Jocelyn Pena-Melnyk introduced it. At first, the insurance companies as a group planned to oppose the legislation. They felt it would set a precedent limiting their ability to manage the costs of medication, which are rising at a time when other medical costs are declining. On the day before the hearing, Maryland Governor Larry Hogan declared a state of emergency regarding the surge in heroin use in the state.

Given the seriousness of the issue, the insurance companies, led by CareFirst Blue Cross, reversed their position and not only dropped their opposition but switched to support the bill. This was so unusual that a photographer took a picture of all of us on the same side of the table supporting the bill.

I was impressed that the committee members had digested the material about buprenorphine and had formulated thoughtful questions as the formal presentations ended.

Many steps must be taken before this bill becomes law. If it does, Maryland will be the second state to have passed legislation to address this problem. New York State approached it through their Office of the Attorney General. An attorney from the Maryland Office of the Attorney General testified that a legislative route would be preferable because it would apply to all insurance companies. I hope that was is being done in Maryland will provide an impetus for similar actions in other states. I will keep readers apprised of how this bill progresses.

Contact us to learn more about buprenorphine.