Coventry Cares reverses course, will continue paying for addiction drug

bmusgrave@herald-leader.comMay 14, 2012 

FRANKFORT — Medicaid provider Coventry Cares has reversed an earlier decision and will continue paying for a costly medication that helps drug addicts stop using opiates, a company spokesman said Monday.

Matt Eyles, a spokesman for Coventry, said the company decided to reverse course after talking to representatives of a chain of addiction treatment clinics that threatened last week to sue Coventry.

Anna Whites, a lawyer who represents SelfRefind, which operates addiction treatment centers throughout Kentucky, said she was notified by Coventry's lawyers on Monday that it would continue to pay for Suboxone, a drug often given to opioid addicts who are dependent on drugs such as Oxycontin and Vicodin.

SelfRefind had threatened to sue Coventry in federal court, saying the managed care company's decision to stop paying for Suboxone violated it's contract with the state Cabinet for Health and Family Services and federal disability laws.

The cabinet, which oversees Medicaid, also sent a letter to Coventry last week warning that its decision to drop coverage of Suboxone would be a contract violation.

"After discussing the issue with SelfRefind, Coventry understands their concerns," Eyles said on Monday. "As result, we will continue covering Suboxone and similar medicines for all Coventry members while we work through the cabinet's process to determine whether these drugs should be covered for certain categories of Medicaid recipients or everyone. "

"It was a very open discussion," Whites said of talks betweent he two companies. "I think they did not want to jeopardize these very vulnerable patients."

Coventry had sent letters to patients who receive Suboxone last week saying that it would not pay for the treatment after the patient's current prescription expired. Coventry also said it would not pay for other drugs given to addicts, including drugs used in alcohol abuse treatment.

The company said Kentucky's Medicaid program only covers full drug treatment — including counseling, inpatient treatment and medications — for pregnant or recently pregnant women and youth under 21.

The patients who got Coventry's letter were receiving the medication through the Medicaid program, but other parts of their treatment — such as counseling — were paid for by the patient.

Coventry's decision to stop paying for Suboxone prompted an outcry from addiction specialists, who say that abruptly stopping the drug could result in relapse, overdose or even death.

Whites said she was told by Coventry lawyers that the managed care company would continue in "good faith" discussions with SelfRefind, state advocates and state agencies regarding best practices for addiction recovery. She said SelfRefind has agreed to hold off filing a lawsuit pending the outcome of those discussions.

"We are hopeful to start that process as early as this week," said Jamie Durham, the CEO of SelfRefind. "Kentucky is at the forefront of the drug abuse crisis and by working collaboratively to solve this issue we can be an example to other states on how best to combat this epidemic."

The state moved to managed care in the state-federal program for the poor and disabled on Nov. 1. The other two managed care companies hired in November — Kentucky Spirit and WellCare — have not told patients they intend to quit paying for Suboxone.

The medication can cost upwards of $450 for a 30-day supply.

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