Improve Access to MAT for Medicaid Patients

TMA Written Testimony

House Human Services Committee
House Bill 3286 by Rep. J.D. Sheffield, DO 

Apr. 9, 2019

On behalf of the Texas Medical Association, we would like to offer our support of House Bill 3286 by Rep. J.D. Sheffield. We applaud Chair Frank, Vice-Chair Hinojosa, and the entire House Human Services Committee for your commitment to Texans with substance use disorder (SUD). HB 3286 has the potential to expedite treatment for recipients of Medicaid with SUD, allowing for quicker access to life-saving prescriptions. 

One of Texas’ biggest public health crises is the unmet treatment of SUD. Texas physicians see this firsthand every day. Alcohol is the primary drug abused in Texas. Nearly one in three patients admitted into publicly funded treatment programs in Texas had a primary diagnosis involving alcohol. However, other substances continue to play a significant role in substance use morbidity and mortality. For example, methamphetamine use is a growing problem in Texas. In 2017, there were close to 800 deaths due to methamphetamine in Texas, compared with around 500 from heroin.  Additionally, the number of people admitted into treatment with a primary problem with benzodiazepines, especially Xanax, is increasing.

In light of Texas’ focus on maternal mortality and morbidity, we must acknowledge that substance abuse among pregnant and postpartum women poses significant potential harm to mother and baby. According to the most recent data compiled by the Texas Maternal Mortality and Morbidity Task Force, drug overdoses are the leading cause of maternal death during and after pregnancy, with most deaths occurring after the 60-day postpartum period. In a majority of cases (77%), a combination of drugs was used, though legal and illegal opioids were detected in 58 percent of cases.  As the rate of opioid misuse among pregnant women has increased, so too has the incidence of neonatal abstinence syndrome (NAS), a condition in newborns caused by the sudden withdrawal of opioids taken by the mother. Between 2010 and 2014, rates of NAS in Texas increased by 51.3%.  

While many patients want treatment for their SUD, they often lack access to the most effective treatment for their individual needs. With proper treatment and support, people with SUD can recover and live, work, and contribute to the community. SUD can be successfully managed, generally with a combination of several evidence-based practices such as medication-assisted treatment (MAT), individual or group counseling, and inpatient residential treatment. As the opioid addiction epidemic has metastasized and recognition of SUD as a medical disorder rather than a character flaw has expanded, more people with mild to moderate SUD are contacting their doctors for treatment. 

MAT is one of the most effective evidence-based treatments for SUD. MAT uses both medication and long-term counseling to provide a whole-patient approach to the treatment of substance dependencies. The different medications used in MAT have various effects. Some can take away cravings, while others eliminate or decrease the effectiveness of certain opioids, decrease withdrawal symptoms, relapse, overdose, or criminality; and ultimately decrease the likelihood of death.   

HB 3286 would increase overall access to much needed MAT by Medicaid recipients, which TMA supports. While recognizing the need for expedited access to MAT prescriptions for patients with SUD, TMA supports adding safeguards to the legislation to ensure that physicians can keep their patients’ safety the highest priority when engaging in MAT. For that reason, TMA recommends that the bill clarify that prior authorizations and clinical edits still be allowed for a patient with contraindications to a particular drug. Further, we recommend age-related restrictions for patients who may need special considerations. Finally, we recommend removing methadone from the list of MAT options for which no prior authorization is needed. Physicians who treat patients with SUD recognize the effectiveness of methadone while simultaneously acknowledging the highly addictive nature of the drug. Therefore, we recommend that prior authorization for methadone stay intact. 

While SUD is a chronic condition requiring ongoing management for most patients, TMA recognizes the shift to providing evidence-based MAT. Evidence shows that this type of treatment combination – medication and traditional outpatient therapies, such as group counseling – results in reduced recidivism and mortality rates, allowing patients to return to being productive members of society.  

 

We appreciate the opportunity to offer support and additional potential policy opportunities for HB 3286. Thank you for your consideration.  

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Last Updated On

April 09, 2019