Effective Grant Management Increases Access to MAT

As the opioid epidemic continues to grow in our country, leading to a rise in addiction that is affecting individuals form all socioeconomic classes, we grapple as a society with how to provide the necessary treatment and funding to support all those seeking care.

Medication-assisted treatment continues to be one of the most effective modalities available to those patients looking to overcome their addiction. The use of medications to curtail withdrawal symptoms, allowing individuals to regain control of their lives is critical in effectively managing their addiction. The use of medications such as buprenorphine has been shown to be extremely effective in the management of symptoms associated with discontinuing opioids. Unfortunately, the cost associated with treatment using such medications can be large, as can be the disparity in pricing throughout the country on these treatments.

Our recent analysis shows markups on certain medications to be over 200%. Not-for-profit treatment facilities utilize grants to subsidize payment on these medications for patients who struggle to maintain access to care without adequate insurance. We are seeing the federal government continuously increasing its levels of funding to meet the needs of a growing patient base grappling to beat addiction. On a state level, Colorado attorney general Phil Weiser recently took a significant step forward, distributing $400 million in funds that the state stands to receive from lawsuits filed against distributors and manufacturers of opioids. The funds will be used to increase access to care for those in need and expand upon current treatment options. 

Still, the cost of MAT remains elevated and arbitrary throughout the country. Proper creation and management of drug formularies for the grant-based system have been non-existent until recently. Programs, such as those introduced by NewStart Rx Network, are being developed to create and manage customized formularies for not-for-profit treatment centers, providing their patients with MAT therapy at reduced consistent prices. The use the independent pharmacies throughout the country who agree to a reduced pricing model helps to control costs while ensuring a positive patient experience through their credentialed pharmacy network. On top of the direct savings associated with the “cost +” pricing model are savings related to the operational efficiencies these formulary management organizations provide, as they offer a simplified reconciliation process to treatment centers, taking a large burden off of their finance teams.

The concept allows facilities to stretch their grant allocations without additional funding. The tools are available to provide access to MAT therapy at a substantially reduced price. Formulary creation and management is done in the private sector on a daily basis through both large and small group insurers. Ensuring that all parties receive adequate and fair payment for their services, but on a fair and consistent pricing model should be common practice.

Substance use disorder and mental health treatment centers do their part in providing patients battling addiction with necessary resources. Incorporating cost solution methods such as a “cost +” model can be an effective tool to increase MAT access to all those in need.

Jonathan Mordis, PharmD, is interim president of NewStart Rx.