Call to Order and Roll Call
The 2nd meeting of the Budget Review Subcommittee on Human Resources of the Interim Joint Committee on Appropriations and Revenue was held on<Day> Thursday, August 25, 2016, at 11:00 AM, in Room 149 of the Capitol Annex. Senator Ralph Alvarado, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Ralph Alvarado, Co-Chair; Representative Joni L. Jenkins, Co-Chair; Senators Carroll Gibson, Denise Harper Angel, and Morgan McGarvey; Representatives George Brown Jr., Tom Burch, Donna Mayfield, David Watkins, Jim Wayne, and Addia Wuchner.
Guests: Stephen Miller, Commissioner, Department for Medicaid Services, Cabinet for Health and Family Services (CHFS); Dr. Allen J. Brenzel, MD, Clinical Director, Department for Behavioral Health, Developmental and Intellectual Disabilities, CHFS; Robert S. Silverthorn, Jr., Inspector General, CHFS; Dr. Molly Rutherford, MD, President, Kentucky Society of Addiction Medicine; Dr. Robert Couch, MD, Emergency Room Physician, Louisville, Ky; Dr. Robert Goforth, Pharm. D., R.Ph., Independent Pharmacist, Clay, Jackson, and McCreary Counties; Jill Lee, R. Ph., Pharmacist Consultant, Drug Enforcement and Professional Practices, Office of the Inspector General; Joseph Michael Cox, LPCC, President, Isaiah House/Patricia's Place; Brad Garrett, Recovered Addict; Melodie Schrader, Executive Director, Kentucky Association of Health Plans; Theresa Wilp, APRN, Bluegrass Family Care Center; and Scott Hesseltine, MA, MBA, LADC, Vice President of Addiction Services, Seven Counties Services.
LRC Staff: Miriam Fordham, Jonathan Eakin, and Benjamin Thompson.
Approval of Minutes
Representative Brown made a motion, seconded by Senator Gibson, to approve the minutes of the August 1, 2016 meeting. The motion carried by voice vote.
Overview of Medicaid Costs and Coverage of Medication-Assisted Treatments for Substance Use Disorders
Commissioner Miller, Dr. Brenzel, and Inspector General Silverthorn provided a brief presentation on substance use disorders in Kentucky and the Medicaid costs and coverage associated.
In response to a question from Chair Alvarado, Dr. Brenzel said diversion, or the illegal use of prescription drugs, is an issue about which CHFS is aware concerned.
In response to a question from Senator Gibson, Commissioner Miller stated that the dollar cost to Medicaid for medication-assisted treatment prescriptions had risen from $2 million per month in January 2014 to $5 million per month as of June 2016. Dr. Brenzel said much of the increase in cost occurred with the expansion of Medicaid.
In response to a question from Representative Wuchner, Commissioner Miller confirmed that there are 470 licensed addiction treatment prescribers in Kentucky and that 14 of them have reached their 100 patient maximum capacity.
In response to a question from Representative Brown, Commissioner Miller confirmed that Medicaid expansion has allowed more individuals to seek treatment for their substance use disorders.
In response to questions from Representative Wayne, Dr. Brenzel said many of the physicians with a license to prescribe medication-assisted treatments are in private practice. Dr. Brenzel stated that medication alone is not considered medication-assisted treatment. It would be inappropriate to prescribe medication without additional treatment methods, such as therapy. In some cases, patients get medication without additional treatment, but there isn't currently enough data to stop those instances. A prescriber does not have to be a board certified addictionologist but must have additional training before applying to the DEA for a license to prescribe medication for substance use disorders.
In response to a question from Representative Jenkins, Dr. Brenzel stated that CHFS is attempting to use its data to determine outlier prescribers.
In response to a question from Chair Alvarado, Dr. Brenzel confirmed the 100 prescription limit for prescribers is a federal policy.
Medication-Assisted Treatments for Substance Use Disorders - Physicians' Perspective
Dr. Rutherford presented on effective ways to treat substance use disorders and on the variety of situations seen by physicians working in the field.
In response to questions from Chair Alvarado, Dr. Rutherford stated that physicians have ways to prevent diversion. Dr. Rutherford said that she discontinues treatment if a patient stops taking medications as prescribed. She weens patient dosages down on Suboxone and eventually transitions to Vivitrol.
Tamper Resistant Drugs
Representative Wuchner and Dr. Couch provided a presentation on the development and benefits of tamper resistant drugs.
Medication-Assisted Treatments for Substance Use Disorders - Pharmacists' Perspective
Dr. Goforth, Ms. Lee, Mr. Cox, and Mr. Garrett testified on the ways that prescriptions used to treat opioid addiction, such as Suboxone, are diverted to the streets.
In response to a question from Chair Alvarado, Dr. Goforth said that his pharmacy reports every physician that it suspects of providing improper prescriptions.
Medication-Assisted Treatments for Substance Use Disorders - Medicaid Managed Care Organizations
Ms. Schrader provided a Medicaid Managed Care Organization perspective on coverage and costs for medication-assisted treatments for substance use disorders.
Use of Vivitrol in Treatment for Opioid Addiction
Ms. Wilp provided testimony on the benefits of using Vivitrol, rather than Suboxone or a similar medication, to treat substance use disorders.
In response to a question from Chair Alvarado, Ms. Wilp stated that it is very difficult to get Vivitrol preapproved by insurance companies.
Medication-Assisted Treatments in Kentucky Drug Treatment Clinics
Mr. Hesseltine presented an overview of how Seven Counties Services utilizes medication-assisted treatments in dealing with opioid addiction.
In response to a question from Representative Jenkins, Mr. Hesseltine said Kentucky does not have enough substance abuse counselors to meet the demand for treatment.
There being no further business before the subcommittee, the meeting was adjourned at 1:31 PM.