BILL ANALYSIS
AB 417
Page 1
Date of Hearing: May 28, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 417 (Beall) - As Amended: May 19, 2009
Policy Committee: HealthVote:18 - 0
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill requires buprenorphine services to be included within
the scope of Drug Medi-Cal services. Specifically, this bill:
1)Requires buprenorphine services to be included within the
scope of Drug Medi-Cal services, but only if the services are
administered by a licensed narcotic treatment program and
ordered or prescribed by a physician who complies with federal
requirements.
2)Provides these provisions will not be implemented if the
Director of Health Care Services determines that they would
require an unbundling of Drug Medi-Cal reimbursement rates.
FISCAL EFFECT
1)If 10% of current methadone patients convert to buprenorphine
and their time on the drug averages three months (as evidence
suggests) rather than the much longer treatment using
methadone, the savings to the Drug Medi-Cal program would be
in excess of $20 million ($10 million GF).
2)Workload associated with adding buprenorphine to the current
bundled rate should be minor, likely less than $100,000.
COMMENTS
1)Purpose . According to the author, this bill requires DADP to
allow for the use of buprenorphine treatment in narcotic
treatment programs. Under current law, narcotic treatment
programs are only eligible to claim reimbursement for two
medication-assisted treatments: methadone and
AB 417
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levo-alphacetylmethadol (LAAM). LAAM is no longer
manufactured, leaving methadone as the only treatment option.
Buprenorphine was approved for use in the treatment of opioid
addiction in 2002 through federal law, and the author states
that private sector health care and insurance cover
buprenorphine. To date, DADP has not authorized reimbursement
for buprenorphine therapy in the Drug Medi-Cal program.
The unavailability of buprenorphine as a therapy option has
created a two-tiered system of care that the author argues
prevents providers from utilizing the most advanced medication
available. The author states substance abuse exacts a
devastating toll in California, ruining lives, destroying
families, and devouring tax dollars. According to the author,
more than 70% of the costs associated with prison, parole,
local criminal adjudication, and child welfare are related to
untreated alcohol and other drug abuse problems. The author
states that in 2005 alone, California spent $44 billion
rectifying the fallout from drug and other alcohol abuse.
Research shows that substance abuse treatment is effective,
but is most effective when tailored to meet the needs of the
individual. This bill adds an additional option for treating
substance abuse
2)Drug Medi-Cal provides five different statutorily defined
modes of treatment services: a) Narcotic treatment; b)
Naltrexone; c) Outpatient drug free; d) Day care habilitative;
and, e) Perinatal residential services. These services are
provided in an outpatient setting. Drug Medi-Cal services are
reimbursed on a fee-for-service basis at maximum rates set by
the state, and are not provided through Medi-Cal managed care
plans. These community treatment services are "carved out"
from the regular Medi-Cal Program, which means that they are
delivered by a specialized system of providers certified by
the state rather than through participating physicians or
health plans. Drug Medi-Cal served 58,829 persons in 2007-08
with an alcohol or drug abuse problem. The governor's 2009-10
budget proposed to fund Drug Medi-Cal through a new special
fund called the Drug and Alcohol Prevention and Treatment
Fund, which was to be supported by an increase in the excise
tax on alcohol (the "nickel-a-drink" tax). That proposal was
not adopted by the Legislature. The 2009-10 budget for Drug
Medi-Cal has a total estimated budget of $220 million ($114.3
million General Fund).
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3)Buprenorphine . Buprenorphine is used to treat addiction to
opioids by preventing withdrawal symptoms so that a person can
stop taking the opioid drug to which he or she is addicted.
In October 2002, the FDA approved two buprenorphine products,
Subutex and Suboxone, for use in opioid addiction treatment.
Subutex and Suboxone were the first narcotic drugs available
for the treatment of opiate dependence that can be prescribed
in an office setting under the federal Data Addiction
Treatment Act (DATA) of 2000. Prior to DATA, opiate
dependence treatments like methadone could be dispensed in a
limited number of clinics that specialize in addiction
treatment. Under DATA, medications for the treatment of
opiate dependence are subject to less restrictive controls.
Buprenorphine can be prescribed in an office-based setting by
specially qualified physicians, and patients can obtain a
30-day supply from a pharmacy.
4)Legislative Analyst's Office (LAO) Drug Medi-Cal Study . In its
analysis of the governor's proposed 2004-05 budget, the LAO
recommended, as part of its proposal to contain state costs
for methadone services, the Legislature consider integrating
buprenorphine into Drug Medi-Cal. The LAO indicated it was
advised that for many clients buprenorphine treatment offers
advantages over methadone. It can be distributed in tablet
form through the offices of qualified physicians instead of
just through narcotic treatment clinics, potentially making
these services more widely accessible to clients without the
stigma perceived from visitation to a drug-treatment clinic.
Formulation of the drug in a combination with another
medication called naloxone lowers the risk that the drug
itself can be abused, as has sometimes been the case for
methadone.
The LAO states published medical evaluations show that it is
less toxic and poses fewer medical risks to clients, and that
treatment can often be phased out in a shorter period of time
than methadone. The LAO indicates that while the cost per
dose for buprenorphine is higher than for methadone, the
overall cost per treatment episode can be lower for
buprenorphine due primarily to the shorter duration of
treatment.
The LAO notes the Legislature has the option of formally
integrating the medication through statutory and regulatory
changes into both the regular Medi-Cal Program and Drug
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Medi-Cal, and modifying state licensing and certification
procedures for treatment programs.
Analysis Prepared by : Julie Salley-Gray / APPR. / (916)
319-2081