BILL ANALYSIS
AB 417
Page 1
ASSEMBLY THIRD READING
AB 417 (Beall)
As Amended May 19, 2009
Majority vote
HEALTH 18-0 APPROPRIATIONS 12-0
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|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Ammiano, Charles |
| |Ammiano, Block, Carter, | |Calderon, Davis, Fuentes, |
| |Conway, De La Torre, De | |Hall, John A. Perez, |
| |Leon, Emmerson, Hal, | |Price, Skinner, Solorio, |
| |Hayashi, Hernandez, | |Torlakson, Krekorian |
| |Bonnie Lowenthal, | | |
| | Nava, V. Manuel Perez, | | |
| |Salas, | | |
| |Audra Strickland | | |
|-----+--------------------------+-----+---------------------------|
| | | | |
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SUMMARY : Requires buprenorphine services to be included within
the scope of Drug Medi-Cal services, subject to certain
requirements; requires a separate narcotic replacement therapy
dosing fee for buprenorphine to be established; and, prohibits
this bill from being implemented if the Department of Health Care
Services (DHCS) determines the provisions of this bill require an
unbundling of Drug Medi-Cal reimbursement rates. Specifically,
this bill :
1)Requires buprenorphine services to be included within the scope
of Drug Medi-Cal Services, but only if buprenorphine is:
a) Administered by a licensed narcotic treatment program
(NTP) and ordered or prescribed by a physician who complies
with federal requirements and works under the license of the
NTP; or,
b) Prescribed by a physician who complies with federal
requirements but does not work under the license of an NTP.
2)Requires the Department of Drug and Alcohol Programs (DADP) to
establish a separate narcotic replacement therapy dosing fee for
buprenorphine. Requires DADP, for purposes of establishing the
dosing fees, to include comprehensive services that include
physician and medication services.
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3)Adds buprenorphine to the list of controlled substances
authorized for use in replacement narcotic therapy by licensed
NTPs.
4)Defines "buprenorphine" as buprenorphine or buprenorphine
combination products approved by the federal Food and Drug
Administration (FDA) for maintenance or detoxification of opioid
dependence.
5)Prohibits the above provisions from being implemented if the
director of DHCS determines these provisions would require an
unbundling of Drug Medi-Cal reimbursement rates, and states
legislative intent that this bill not result in the unbundling
of reimbursement rates for Drug Medi-Cal Services.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
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 General Fund).
2)Workload associated with adding buprenorphine to the current
bundled rate should be minor, likely less than $100,000.
COMMENTS : According to the author, this bill requires DADP to
allow for the use of buprenorphine treatment in NTPs. Under
current law, narcotic treatment programs are only eligible to
claim reimbursement for two medication-assisted treatments:
methadone and LAAM (levoalphacetylmethadol). 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
private sector health coverage also 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 cost associated with prison, parole, local
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criminal adjudication, and child welfare are related to untreated
alcohol and other drug abuse problems. The author continues 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, and this bill adds an
additional option for treating substance abuse.
Prescription pain relievers like morphine, oxycodone, and codeine
are opioids. 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 Drug Addiction Treatment Act (DATA) of 2000. Under DATA,
medications for the treatment of opiate dependence are subject to
less restrictive controls. Subutex and Suboxone are available
through "regular" Medi-Cal (not Drug Medi-Cal) with a treatment
authorization request, but there is not a reimbursement rate
amount established through Drug Medi-Cal administered by DADP. In
2008, there were 3,764 prescriptions dispensed in Medi-Cal for the
two medications, with a total amount paid of $890,505.
In its analysis of the Governor's proposed 2004-05 Budget, the
Legislative Analyst's Office recommended, as part of its proposal
to contain the fast-growing state cost for methadone services, the
Legislature consider integrating buprenorphine into Drug Medi-Cal
Health care providers and drug treatment advocates argue
buprenorphine is a safe and affective alternative to methadone for
treating opioid dependence when used under the supervision of a
physician.
Analysis Prepared by : Scott Bain / HEALTH / (916) 319-2097
AB 417
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