MaineCare’s New Medication Assisted Treatment (MAT)/Methadone Maintenance Therapy (MMT) Policy

1. MaineCare’s New Medication Assisted Treatment (MAT)/Methadone Maintenance Therapy (MMT) Policy Kevin S. Flanigan, MD Medical Director Office of MaineCare Services

2. Agenda Time Topic and Presenter 5:30- 5:40 Introduction Stefanie Nadeau, Director of MaineCare Services, DHHS 5:40- 5:50 Medication Assisted Treatment Resources, Tracy Weymouth, State Opioid Treatment Authority, Office Substance Abuse and Mental Health Services 5:50- 6:30 Suboxone Redesign Planning and Partnership, Kevin Flanigan MD, Medical Director, MaineCare Services, DHHS 6:30- 6:45 Prior Authorization (PA) Process, Kevin Flanigan MD, Medical Director, MaineCare Services, DHHS 6:45- 7:00 Questions and Answers

3. Medication Assisted Treatment Resources • Responsible Opioid Prescribing: A Clinician’s Guide by Scott M. Fishman MD • Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction TIP 40 • Medication-Assisted Treatment For Opioid Addiction in Opioid Treatment Programs TIP 43 • Buprenorphine: A Guide for Nurses TAP 30 • Clinical Drug Testing in Primary Care TAP 32 • Buprenorphine Treatment: A Training for Multidisciplinary Addiction Professionals – New England ATTC Addiction Technology Transfer Center Network www.attcnetwork.org • Ohio – Low Dose protocol for the Use of Buprenorphine and Suboxone • Vermont – Vermont Buprenorphine Practice Guidelines

4. Suboxone Demand • One of the fastest growing pharmaceutical expenses in MaineCare’s pharmacy budget • We anticipate an increased need among MaineCare patients as with restrictions to opioid coverage and new pain management policy implementation in January 2013 there may be more members seeking addiction treatment.

5. Suboxone Changes • New legislation passed in Spring 2012 • Creates a lifetime limit of 24 months of Suboxone treatment, effective January 1, 2013 • Retroactive application of lifetime limit • Prior Authorization for Suboxone treatment when found “medically necessary”

6. Partnership • MaineCare leadership requests both clinical input for recommendations and stakeholder advisement • Stakeholder partnership with MaineCare is key • Medical provider participation • Administrators • Advocate participation(patient & provider) • Patient participation

7. Planning Phase Starting in the summer of 2012, all partners came together to discuss the following: • The new law • Patient management and care • Goals of a new MaineCare policy • Prior Authorization (PA) process • Risks, benefits & options

8. Objectives of Thoughtful Planning • Stakeholder partnership • Clear goals for Suboxone changes • Evidenced-based recommendations • Consensus-based recommendations

9. Successes Realized from Summer 2012 Suboxone Workgroup • A collaborative effort to plan for patient management and care • Revised PA process • A new foundation for a working relationship between MaineCare, providers & patients!

10. New Suboxone Policy • New MaineCare Suboxone policy that is: • Created as a result of clinically appropriate recommendations • Sensitive to the needs of MaineCare patients • Supportive of evidence- based practices • Reflective of the Department’s budget limitations

11. Prior Authorization (PA) Redesign • Prior Authorization (PA) allowed if “medically necessary” • What does that mean? • How do I get Prior Authorization? • Draft Suboxone Continuation PA Form • Draft Suboxone Restart PA Form

12. Preamble from Suboxone Workgroup • Preamble drafted from Suboxone workgroup • Fundamentals of Suboxone/buprenorphine treatment

13. Questions?

14. Thank you for attending today’s meeting. If you have additional questions or comments, please email: Kevin Flanigan MD, MaineCare Medical Director at: Kevin.Flanigan@maine.gov All meeting materials will be posted at: