SUBOXONE /VIVITROL WEBINAR. Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12

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1 SUBOXONE /VIVITROL WEBINAR Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12

2 WEBINAR INTRODUCTIONS Cynthia Parsons- Program Manager Behavioral Health WV Medicaid Lisa Richardson- Trainer/Consultant-APS Healthcare Christy Gallagher Trainer/Consultant-APS Healthcare

3 MEDICAL NECESSITY Medical Necessity is services and supplies that are: (1) appropriate and necessary for the symptoms, diagnosis or treatment of an illness; (2) provided for the diagnosis or direct care of an illness; (3) within the standards of good practice; (4) not primarily for the convenience of the plan member or provider; and (5) the most appropriate level of care that can be safely provided

4 SUBOXONE /VIVITROL - MEDICATION PHARMACOLOGIC MANAGEMENT PROCEDURE CODE: SERVICE UNIT: Event SERVICE LIMITS: Two events per month with registration PAYMENT LIMITS: Members may not receive Psychiatric Diagnostic Interview Evaluation (procedure code 90801) or Mental Health Comprehensive Medication Services (procedure code H2010) on the same day is provided. PRIOR AUTHORIZATION: Yes, Refer to APS Health Care Utilization Management Guidelines. DEFINITION: Pharmacologic Management services include prescription, use, and review of medication by a psychiatrist/physician, with no more than minimal medical psychotherapy. DOCUMENTATION: The psychiatrist/physician must complete and sign an activity note describing the service provided. The documentation must include: consumer s response to medication, reason for encounter (scheduled/unscheduled), place of service and date of service.

5 VIVITROL -PHARMACY PRIOR AUTHORIZATION CRITERIA Requests for Vivitrol will be authorized if the following criteria are met: Vivitrol is prescribed for the treatment of alcohol and/or opioid dependence for patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment or for prevention of relapse to opioid dependence following opioid detoxification. The patient is opioid free at the time of administration (for treatment of alcohol dependence or prevention of relapse to opioid dependence) and is not in acute opiate withdrawal. (Patient cannot have failed the naloxone challenge test or have positive urine screen opioids.

6 VIVITROL -PHARMACY PRIOR AUTHORIZATION CRITERIA- CONT The patient is 18 years of age or older There is documentation of availability of counseling as well as other supports such as NA/AA groups that offer support during treatment for alcohol dependence or prevention of relapse of opioid dependence. The patient does not have liver failure or hepatitis The patient has not previously exhibited hypersensivity to naltrexone ne, PLG, carboxymethylcellulose, or any other components of the diluent..

7 SUBOXONE PHARMACY PRIOR AUTHORIZATION CRITERIA Prior Authorization request must be made in writing by an approved prescriber on the designated PA form by fax or electronic submission. Prescribed by a licensed physician who qualifies fro a waiver under the Drug Addiction Treatment ACT (DATA ) and has notified the Center for Substance Abuse Treatment of the intention to treat addiction patients and has been assigned a DEA (X) number.

8 SUBOXONE PHARMACY PRIOR AUTHORIZATION CRITERIA-CONT. Prescribed by a WV Medicaid enrolled provider (enrolled directly, enrolled with WV Medicaid HMO, employed by a facility that is enrolled that is enrolled with WV Medicaid) who certifies he/she is treating the patient and billing WV Medicaid for this service.

9 SUBOXONE PHARMACY PRIOR AUTHORIZATION CRITERIA-CONT. Confirmed diagnosis of opioid dependence. o Diagnosis Code Required The Patient is at least 16 years old Subutex will only be approved during pregnancy Maximum initial dose is 24mg per day for a maximum of a 60 day period.

10 SUBOXONE PHARMACY PRIOR AUTHORIZATION CRITERIA-CONT. Maximum initial dose is 24 mg per day for a maximum of a 60 day period; initial dosing is limited to once per lifetime. Maximum maintenance dose is 16mg per day (tablet splitting for lower doses is required, when appropriate) Early refills are not permitted, including replacement of lost or stolen medication

11 PA is limited to: SUBOXONE PHARMACY PRIOR AUTHORIZATION CRITERIA-CONT. o Drug naïve patients : 7 day supply per prescription for a 3-month period, then; o If compliant with treatment plan: 14-day supply per prescription for a 6 month period, then; o If compliant with a treatment plan: 30 day supply per prescription per 6 month interval. Combination with benzodiazepines, hypnotics, and opioids (including tramadol ) will be denied.

12 SUBOXONE PHARMACY PRIOR AUTHORIZATION CRITERIA-CONT. Attestation from prescriber that the Board of Pharmacy Prescription Drug Monitoring Program database has been reviewed for other drug use including benzodiazepine, sedative/hypnotics and opioids. Patient must be warned about the dangers of ingesting concurrent sedating medications

13 NON-METHADONE MEDICATION ASSISTED TREATMENT Non-Methadone Medication Assisted Treatment Guidelines: West Virginia Medicaid covers the following non-methadone Medication Assisted Treatment Services: Individuals seeking opioid addiction treatment with Subutex/Suboxone or alcohol addiction treatment with Vivitrol, must be evaluated by an enrolled physician as specified below, before beginning medication assisted treatment. An initial evaluation may be completed by a staff member other than the physician however no medication may be prescribed until the physician has completed their evaluation. Members seeking treatment with Subutex/Suboxone must have a diagnosis of opioid dependence or Members seeking treatment with Vivitrol, must have a diagnosis of alcohol and/or opioid dependence. All physicians agree to adhere to the Coordination of Care Agreement (see Attachment 1) which will be signed by the member, the treating physician and the treating therapist. If a change of physician or therapist takes place, a new agreement must be signed. This agreement must be placed in the member s record and updated annually.

14 NON-METHADONE MEDICATION ASSISTED TREATMENT-CONT. Physician Requirements: The physician responsible for prescribing and monitoring the member s treatment must have a degree as a Medical Doctor and/or Doctor of Osteopathic Medicine. Must be licensed, board certified and in good standing in the state of West Virginia. Requirements for the Drug Addiction Treatment Act of 2000 (DATA 2000) must be met by the physician unless indicated by Substance Abuse Mental Health Services Administration (SAMHSA). Physicians must be included on the DATA Physician Locator. The physician must be an enrolled WV Medicaid provider.

15 NON-METHADONE MEDICATION ASSISTED TREATMENT-CONT. Therapy Services are face to face structured interventions (e.g. psychotherapy, specialty therapies, family preservation interventions, etc.) designed to improve a member s cognitive processing and/or functional abilities. The intent of this type of intervention is to focus on the dynamics of a member s problems (i.e., the cause of the member s dysfunctions; resolution of intrapsychic/interpersonal conflicts; eliciting change in behavior patterns; and to produce change toward identifiable goals.) Interventions are grounded in a specific and identifiable theoretical base that provides framework for assessing change. This service may be provided in a variety of outpatient settings, but in all settings the service must be provided on a scheduled basis by designated staff. Any therapeutic intervention applied must be performed by a minimum of a Master s Level Therapist using generally accepted practice of therapies recognized by national accrediting bodies of psychology, psychiatry, counseling, and social work. Alcohol Drug Counselor (ADC) or higher level accreditation in addictions and Psychologists may be treating therapists for individuals utilizing Subutex/Suboxone or Vivitrol. In addition, LCSW, LICSW, LPC or therapists with Master s Level Degrees and 2+ years of documented experience in the substance abuse field may provide therapy services.

16 NON-METHADONE MEDICATION ASSISTED TREATMENT-CONT. Documentation: Documentation must include a Master Service Plan and an individual therapeutic intervention plan which expands on the more generalized objectives in the Master Service Plan. The plan must also include a schedule detailing when therapy services are to be provided. For each therapy service, there must be an activity note describing each service or activity provided; the relationship of the service or activity to a specific objective(s) (based upon Medical Necessity) in the therapy plan, the actual intervention utilized and the outcome (consumer s response) of the service. The documentation must include the signature and credentials of the staff providing the service, place of service, date of service.

17 NON-METHADONE MEDICATION ASSISTED TREATMENT-CONT. Required Timelines: Members will attend a minimum of four (4) hours of therapeutic services per month. The four hours must contain a minimum of one (1) hour individual professional therapy session per month. Frequency of therapeutic services may increase based upon medical necessity. Reviews: Prescribing providers are subject to retrospective review of cases to verify compliance with requirements identified in this document. Reviews will be conducted by BMS or its designee.

18 NON-METHADONE MEDICATION ASSISTED TREATMENT-CONT. Drug Screens: A minimum of two (2) random urine drug screens per month are required. A record of the results of these screens must be maintained in the member s record. The drug screen must test for, at a minimum, the following substances: Opiates Oxycodone Methadone Buprenorphine Benzodiazepines PCP/LSD Amphetamine Methamphetamine Alcohol

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22 QUESTIONS/FAQ S If you have any questions please them to Cynthia Parsons and with these questions we will build the FAQ s that will be permanently posted to the HCBS Webpage as shown on a previous slide.

23 CONTACTS Christy Gallaher, APS Trainer/Consultant at Lisa Richards, APS Trainer/Consultant at Emily Proctor, APS, Cynthia Parsons Program Manager Behavioral Health WV Medicaid -

24 WEBSITES OF INTEREST

25 THANK YOU AND WE LOOK FORWARD TO WORKING WITH ALL OF YOU

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