Medicaid program limits opioid supply
Prescriptions for the narcotic now max out at 7 days.
TALLAHASSEE — As lawmakers consider proposals to limit opioid prescriptions, Gov. Rick Scott’s administration is taking steps to do the same in the Florida Medicaid program.
The Agency for Health Care Administration announced last week that, effective Feb. 5, prescriptions for narcotics in the Medicaid program will be limited to a maximum seven-day supply. Medicaid also is no longer requiring prior authorization for certain medication-assisted treatments to help fifight opioid addiction including monthly shots of the drug Vivitrol.
The changes, among others, are being made to “assist in the prevention and treatment of substance use disorders,” the agency said in a Medicaid alert about the decisions.
Proponents say the shifts in policy will go a long way to help the state curb the use of opioids, which are narcotic pain medications and have caused widespread overdoses. In 2016, heroin caused 952 deaths in Florida, fentanyl caused 1,390 deaths, oxycodone caused 723 deaths, and hydrocodone c aused 245 deaths. Those statistics led Scott in May 2017 to declare a state of emergency.
The Medicaid adjustments, in part, track legislative proposals for other patients. Those proposals would limit prescriptions for opioids to three-day supplies but also allow for up to seven-day supplies if physicians deem it medically necessary.
The new Medicaid policy also allows an exemption to the seven-day cap if physicians believe it’s medically necessary to prescribe more. Unlike the legislative proposals, though, there isn’t a limit on medically necessary prescriptions.
Many surgeons and physicians don’t like the limits. Florida Medical Association General Counsel Jeff Scott last week urged lawmakers to allow for exceptions to the limits in situations such as when patients undergo major surgery, have cancer or are in hospice.
Chris Nuland, a lobbyist for the Florida Chapter of the American College of Surgeons, said he doesn’t “like the Medicaid policy,” but said it’s better than what is under consideration by the Legislature.
I n addit i on to l i miti ng prescriptions, the Medicaid program also is eliminating prior-authorization requirements for medication-assisted treatment, specififically naltrexone tablets and Vivitrol.
Additionally, as of Feb. 5, Medicaid will reimburse for a seven-day supply of Suboxone fifilm, which contains buprenorphine and naloxone, or buprenorphine tablets for pregnant or nursing mothers without prior authorization.
The changes impact only the Medicaid program, which provides care to about 4 million Floridians, 85 percent of whom are enrolled in managed-care plans.
In the legislative proposals for other patients, a Senate bill ( SB 8), fifiled by Sen. Lizbeth Benacquisto, R-Fort Myers, would eliminate prior-authorization requirements for medication-assisted treatment. The House version (HB 21), fifiled by Rep. Jim Boyd, R-Bradenton, would not.
It can take weeks to obtain prior authorization for medication-assisted treatments, leaving patients without access to the medications that can help them recover.
Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association, told The News Service of Florida that eliminating the prior-authorization requirements for medically assisted treatment is a step in the right direction.