AUGUSTA, Maine — Drug-addicted Medicaid patients would lose coverage for methadone treatment after two years under a bill green-lighted Monday by a legislative committee.
The bill, LD 1840, limits reimbursement for methadone for opiate addiction to 24 months unless the provider gets approval for longer treatment ahead of time from the Department of Health and Human Services.
The legislation mirrors a similar cutoff placed on Suboxone, another common replacement drug for opiate addicts in treatment, that was approved as part of the last supplemental budget.
The Legislature’s Health and Human Services Committee spent several hours weighing the needs of Medicaid patients trying to get clean against the state’s stewardship of taxpayer-funded health insurance.
MaineCare, the state’s version of the federal Medicaid program, covers roughly three-quarters of all methadone patients in the state, or about 3,500 people.
The bill’s sponsor, Republican Rep. David Burns of Whiting, acknowledged he didn’t have a scientific basis for the two-year cap, but said it seemed reasonable and was in line with the time limit on Suboxone.
“I’m a layperson, I’m not a physician, but it would seem to me after two years of treatment there ought to be enough treatment information there to know if you need to continue, and if so, why shouldn’t that be documented?” he said. “Especially where it’s being covered under MaineCare Services.”
Rep. Linda Sanborn, a Gorham Democrat and retired physician, said the two-year limit fails to recognize that opiate addiction is a disease requiring long-term treatment.
“We’re not looking at setting a length of time on giving people insulin for their diabetes, and we shouldn’t be looking at setting an arbitrary time to treat with methadone,” she said. “It is only because of the stigma that revolves around drug addiction that we’re having this discussion. It has nothing to do with science.”
Recovering addicts take regular doses of methadone to curb cravings as they go through therapy. The dosing and length of treatment varies widely, depending on the individual, and can go on for years.
Heroin addicts generally respond better to methadone, while Suboxone often works better for people addicted to prescription opiates such as OxyContin, said Dr. Kevin Flanigan, medical director of MaineCare Services.
The committee didn’t discuss how much money the state could save by limiting MaineCare reimbursements for methadone treatment. The two-year cap on Suboxone is projected to save about $600,000 in the next fiscal year.
The cap on methadone would not apply to patients using the drug to treat chronic pain.
Dr. Joseph Py, corporate medical director for Discovery House, which runs methadone clinics in Maine and several other states, said the longer patients are in treatment, the better they do.
“I would love to have people drug-free forever after X amount of time,” he said. “What we know about opiates, since people have been using them… is that has not been the case, time and time again.”
The committee voted 8-2 in favor of the methadone bill, which now goes to the full Legislature for a vote. Additional language about MaineCare reimbursement for transportation to methadone clinics, which is included in a separate bill, was removed.