BCBS to shorten Suboxone Coverage in Tennessee

Last edited by nannamom on Thu 13 Jan 2011, 12:14 pm; edited 2 times in total

Thousands of Tennesseans are wondering how they're going to afford medicine that their insurance company suddenly stopped paying for.

The Channel 4 I-Team has confirmed 2,000 customers of Blue Cross Blue Shield of Tennessee have been alerted about the stop of coverage, but there's something unusual about all these patients: they're addicts.

It was when he tried to stop taking his painkillers that one man who suffers from back pain realized he was addicted.

"(I had) severe nausea, cold sweats, nervousness and just unbearable cravings," he said.

His doctor passed him a pamphlet suggesting he give the drug Suboxone a try. It had proven to help painkiller addicts manage their cravings.

"It was the greatest relief I had ever had in my life," said the man, who did not want to be identified.

So when he received a letter from his insurance carrier, Blue Cross Blue Shield of Tennessee, telling him it would no longer cover his medicine, he began to wonder how he could afford the estimated $500 a month to pay for the drug.

"This is going to affect a lot of people, and a lot of people are going to suffer because of this," said the man, who did not want to be identified.

The decision was made to stop covering the drug after six months of use because Suboxone is intended for detox, not long-term use.

"They need to speak with their providers about other options to treat their cravings," said Dr. Terry Shea, the director of pharmacy services with Blue Cross Blue Shield.

"This is going to be disastrous for people," said addiction medicine specialist Dr. Michael Miller.

But Miller said an insurance company shouldn't be the one dictating how long someone needs to be on a drug, especially an expensive drug that's kept addicts clean.

"Most will not be able to afford it. Some will relapse into addiction," said Miller.

The big debate is really how long does it take for an addict to completely detox. Blue Cross Blue Shield said products like Suboxone usually take six to eight weeks to detoxify someone, but Miller said some addicts will always need this medicine to stay clean.

There is also a News Video that comes with this article. To view that actual video you will have to follow the link to the site where the original article was written.
The link to that video is: ~ http://www.wsmv.com/health/25882876/detail.html

The above article saddens me to say the least. For some people, a short Detox may be all they need in regards to Suboxone. But for those patients who have been taking this medication long term what could that mean?
I admit there are days where I really do wish I would have opted for a short detox before taking Suboxone. But that is not a reality when I think back and remember the many times that I tried to stop using in the past without success. Yes, sure I would stay off opiates for a short period of time, but sooner or later I would always go back to what helped me the most. And that was to take opiates.
For me, opiates helped me to function, and to think clearer. At the same time, I was never able to keep my opiate use to a minimum.
Once I started taking a maintenance medication, all of that changed for me. I was able to take back my life.

I just don't see HOW an insurance company can make a decision like this. Who are they to be able to make that decision. Are the specialists? No. Are they actual doctors? No. So who are these people? Who are they to say, what we do and do not need.

To those of you who live in Tennessee, I encourage you to take a stand. Start a petition, write letters, ask questions, something, anything. Take back your rights. And what about the new Health Reform? Where does that figure in here. Can someone please explain that to me?
~nannamom

BCBS to shorten Suboxone Coverage in Tennessee Update10

~Follow up to the News Article posted above~

Vanderbilt study's treatment for drug-addicted mothers helps improve newborns' condition

A new treatment could drastically improve the condition of infants born to drug-addicted mothers.

A study co-authored by the director of the Vanderbilt Addiction Center in Nashville found that babies born with opioid dependency because of their mothers' addiction to painkillers were weaned off the drugs more comfortably and in a shorter period of time if the mother was treated with buprenorphine during the pregnancy. The study was recently published in The New England Journal of Medicine.

Vanderbilt's Dr. Peter Martin said he hopes the study will reassure doctors hesitant to prescribe buprenorphine, as well as insurers that may be reluctant to cover it.

"The most important aspect of this study is I think it's going to have an effect on how physicians practice," Martin said. "It's going to make people understand that buprenorphine might be very viable in this population, and this is something that wasn't known before."

In addition to being the first study of its kind, the results were unusually conclusive, Martin said.

Buprenorphine, also known by the brand names Suboxone and Subutex or the nickname "bupe," is a relatively new addiction therapy drug and an alternative to methadone for eliminating addicts' cravings for opioids, which include pain medication and heroin.

Martin and the other researchers found that babies born to mothers treated with bupe had an average hospital stay of 10 days versus 18 days for babies born to mothers treated with methadone.

"It's an indication they were less sick," Martin said.

Insurers re-evaluate

Opioid-dependent infants suffer withdrawals after delivery and are given morphine when they become especially uncomfortable. In the study, babies born to mothers treated with methadone were given an average of 10 milligrams of morphine. The babies of mothers treated with buprenorphine required less than 1 milligram.

"Not only were they in the hospital longer, but they needed to be treated with morphine longer," Martin said of the infants born to mothers treated with methadone. "Methadone, which is the standard of care, works fine, but buprenorphine works better."

The study - funded by the National Institutes of Health - estimated that prescribing expectant mothers buprenorphine instead of methadone could reduce the public health and medical costs of treating opioid-addicted infants by $70.6 million to $112.6 million a year.

Martin said he hopes insurers will take note. Some, including BlueCross BlueShield of Tennessee and TennCare, the state's Medicaid provider, are re-evaluating their coverage of bupe in response to a skyrocketing number of claims for the expensive drug. TennCare, which limits bupe doses and grants only an initial three-month authorization with the possibility for six-month extensions, uses the same criteria for expectant mothers, spokeswoman Kelly Gunderson said.

"Due to the lack of adequate, well-controlled studies in pregnant women and the potential for neonatal abstinence syndrome, it is recommended that buprenorphine be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus," BlueCross BlueShield of Tennessee spokesman Roy Vaughn said. "If requested by the member's doctor, we will allow coverage of buprenorphine throughout the length of the pregnancy."

Doctor has Worries

Martin, who opposes efforts to limit access to the drug, said he hopes his study will change attitudes about the drug.

Among his worries is that mothers who are approved for the drug during pregnancy will lose coverage once their children are born, potentially leading them to relapse.

"We're going to run into all the same kinds of problems," Martin said. "This is just further evidence to indicate that people can do very well on buprenorphine."

News Article Source:
WBIR.com- "The Tennessean
Posted by:
~nannamom

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