Medicaid managed-care firm Coventry plans to stop paying for expensive drug that curtails addiction

Coventry Cares, one of the four firms that manage patient care for the state Medicaid program, has once again hit the headlines, this time for its plans to stop paying for medicine that helps addicts keep their opioid addiction at bay. State officials quickly condemned the move Thursday and called it a contract violation, reports Beth Musgrave of the Lexington Herald-Leader.

Coventry decided to stop paying for buprenorphine, more commonly known as Suboxone, which helps curtain cravings for drugs such as Oxycontin and Vicodin. A 30-day supply of the drug can cost more than $450, Musgrave reports.
“They will be at risk for relapsing and going back to using illegal opioids,” Dr. Michelle Lofwall, an addiction specialist and assistant professor at the University of Kentucky, told Musgrave. “Whenever you are using illegal opioids, there is a risk of overdose and death.”
Coventry said it will no longer offer the coverage because only pregnant women, women who recently gave birth and those under the age of 21 are eligible for addiction treatment in Kentucky’s Medicaid program. “What we’ve done is align our coverage with the cabinet’s Medicaid policy,” said Matt Eyles, a Coventry spokesman.

However, the state Cabinet for Health and Family Services said the decision violates the contract and “cannot take this unilateral action without the cabinet’s approval,” said Jill Midkiff, a cabinet spokeswoman. 

A company that operates addiction treatment centers across the state was planning to file suit over the move Friday, but, after learning of the cabinet’s reaction, “We are going to give them the chance to work this out,” Anna Whites, an attorney who represents SelfRefind.
Coventry already caused controversy this week when it informed Baptist Health System wants to renegotiate its contract. The move comes just a week after Coventry and Appalachian Regional Healthcare came to a temporary agreement after Coventry threatened to terminate its contract and ARH sued Coventry. The company has also told King’s Daughters Medical Center in Ashland it will terminate its contract after May 26. (Read more)
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