The amount of money taxpayers are spending on Suboxone prescriptions for individuals enrolled in MaineCare has surged to $26.2 million per year, making it the most expensive and most popular drug covered under Medicaid.
According to state health spending data, Medicaid paid out $26,177,048 for Suboxone prescriptions for 7,920 individuals from July 1, 2022 to June 30, 2023.
That’s an increase from the period from July 1, 2019 to June 30, 2020 of $5.6 million per year and nearly 1,000 Suboxone users.
Suboxone, a combination of buprenorphine and naloxone, is used to treat opioid addiction. Versions of the drug come as a patch, sublingual film, and even a transdermal implant. Naloxone serves to block opioids from interacting with the brain, while buprenorphine is itself a powerful opioid sometimes prescribed by itself for pain.
The use of Suboxone to treat opioid addiction has been controversial because the drug has addictive qualities and a high potential for abuse.
Under Republican Gov. Paul LePage, MaineCare did not offer reimbursement for Suboxone, preferring to steer low-income Mainers suffering from opioid addiction toward abstinence-based models of recovery.
When Democratic Gov. Janet Mills took office in 2019, the state expanded eligibility for MaineCare and made Suboxone available to MaineCare enrollees without prior authorization.
The drug is now broadly available and can be acquired from primary care doctors, health clinics, offices that specialize in medication-assisted treatment for opioid addiction, and via telemedicine.
The trend observable in the four years of available data suggests that rather than reducing the total population of Mainers suffering from addiction, Maine has created a new drug of choice for a subset of those suffering from opioid addiction — at a growing cost to tax payers.
The information is made public on an annual basis due to a law passed in 2018 that requires the public disclosure of certain health care expenditure data by the Maine Health Data Organization.
Suboxone was originally developed and marketed by Indivior PLC.
In 2019, around the same time Maine was making Suboxone easier to get for MaineCare patients, Indivior was indicted by the U.S. Justice Department for allegedly making false or misleading claims about Suboxone’s safety and for using online marketing to funnel patients to doctors more likely to prescribe Suboxone.
In 2020, Indivior agreed to pay a $600 million settlement to resolve their civil and criminal liability. Despite the settlement and generic alternatives provided by other drug companies, Indivior remains one of the most dominant drug manufacturers in the medication-assisted treatment industry.
According to the data, there is a significant divergence between the popularity of Suboxone among those on MaineCare versus those with commercial, private insurance, such as an employer provided plan.
Among individuals with private insurance, the most costly drugs from July 1, 2022 to June 30, 2023 were: Humira Pen ($72.1M), Stelara ($59.6M), Enbrel ($17.9M), Trikafta ($14.8M), and Skrizi ($12.7M).
Suboxone did not make the list of the 25 most expensive drugs for the privately insured.
0 Comments