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Medicaid Program Limiting Opioid Prescriptions

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Daylina Miller
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

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 Monday, 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 fight 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 caused 245 deaths. Those statistics led Gov. Rick 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.

Supporters say limiting opioid prescriptions will help stem the use of opioids.

But 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.

“While the surgeons dislike arbitrary limits, at least the Medicaid policy acknowledges there will be cases for which a larger prescription is appropriate,” said Nuland.

Prescribing and usage guidelines for Medicaid are determined in part by panels known as the Pharmaceutical and Therapeutics Committee and the Drug Utilization Review Board, as well as the Agency for Health Care Administration, which has oversight of the Medicaid program.

The Pharmaceutical and Therapeutics Committee meets quarterly and is charged with maintaining a preferred drug list, or the list of approved medications for specific medical conditions. The Drug Utilization Review Board approves drug-use criteria and standards for drug use.       

In addition to limiting prescriptions, the Medicaid program also is eliminating prior-authorization requirements for medication-assisted treatment, specifically naltrexone tablets and Vivitrol, which was added to the preferred drug list after a Pharmaceutical and Therapeutics Committee meeting in January.

Additionally, effective Feb. 5, Medicaid will reimburse for a seven-day supply of Suboxone film, 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), filed by Sen. Lizbeth Benacquisto, R-Fort Myers, would eliminate prior-authorization requirements for medication-assisted treatment. The House version (HB 21), filed 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.

The medications, he said, “help stabilize brains and move people toward a path to recovery.”