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Jeanne Gripshover: Nurse practitioner urges open access to non-opioid drug to address withdrawal

What good is health coverage if access to fundamental, lifesaving treatments is determined by nameless cost controllers and not the practitioners who evaluate patients?

My Florence-based family practice sees numerous Northern and Central Kentucky patients each month, many of whom are suffering from both the physical pain, and the social stigma, of opioid dependency and addiction.

COVID-19 has increased those numbers, an occurrence noted by practitioners statewide who see isolation and other stressors driving substance use. One of the major factors preventing my patients from pursuing recovery, is the legitimate fear of detoxification.

Fortunately, there is FDA-approved medication designed specifically to manage detox symptoms. Unfortunately, many of Kentucky Medicaid’s managed care partners would rather haggle over an ounce of prevention, rather than accept a pound of cure.

Jeanne Gripshover

For nearly two years, I have successfully initiated hundreds of patients on lofexidine, an FDA-approved, non-opioid drug for the mitigation of opioid withdrawal symptoms in adults who quit opioids. Medicaid, often slow to fully embrace new treatment modalities, requires my patients to ‘fail first’ on an off-label cocktail before covering the week-long treatment.

Getting approval is labor-intensive, requiring hours of paperwork and potentially wasting precious time with clients who may never come back for a second visit after failing the first time.

Increasingly, Medicaid’s MCO partners are throwing up their own roadblocks. One Medicaid insurer rejected my patient’s ‘fail first’ documentation, presumably because they didn’t fail thoroughly enough.

A different Medicaid insurer required that the patient fail on a Schedule III, branded, buprenorphine maintenance drug before approving lofexidine.

Most alarming of all, Medicaid’s own pharmacy benefit manager recently rejected a standard prior authorization form and seven pages of supporting diagnostics as ‘illegible.’ That patient was forced to spend the evening in a local hospital, detoxing in an inpatient setting, and incurring what must be thousands of dollars in costs to the health care system.

Opioid withdrawal symptoms are very real; they are not a penance for the already stigmatized to earn the privilege of medication. It is evident that at least some of Kentucky’s managed care organizations are completely rejecting the on-the-ground reality of withdrawal management, choosing either to hide behind cheap, generic, off-label cocktails, or incentivizing the use of scheduled drugs when some patients demand non-addicting alternatives.

The Kentucky General Assembly has wisely compelled the Department for Medicaid Services to adopt a single pharmaceutical formulary across its managed care partners. I hope that my experience and that of my patients – your friends and neighbors – compel the policymakers in Medicaid to guarantee open access to non-opioid, FDA-approved withdrawal management medication.

Jeanne Gripshover is a nurse practitioner with Florence Medical Group.

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