Cigna Behavioral Health (CBH), a nationwide managed care organization and
subsidiary of Cigna Corp., has begun to reimburse physicians for office-based
buprenorphine induction treatment at a higher rate than for regular office
visits.
Sublingual buprenorphine is one of the few pharmacological treatments
approved by the Food and Drug Administration for treating individuals with
opioid dependence. It is a Schedule III narcotic and the only medication
approved to treat opioid dependence at physician offices under the Drug
Addiction Treatment Act of 2000.
The induction phase of buprenorphine treatment costs more than a routine
office visit, because it requires close supervision of the patient at the
physician's office as the patient undergoes opioid withdrawal. The induction
phase may involve several visits and intense monitoring, according to
guidelines in the approved prescribing information provided by the Center for
Substance Abuse Treatment (CSAT). Physicians must titrate the dose of
buprenorphine until the patient can be put safely on an effective maintenance
dose.
To prescribe buprenorphine for outpatient treatment, physicians must first
receive training and certification and register with CSAT. Compared with
methadone (a Schedule II narcotic), buprenorphine gives patients a favorable
alternative because the induction visits are conducted at a physician's
office, as opposed to designated clinics, and the maintenance therapy can be
achieved in the privacy of patients' homes.
In May CBH announced that it had adopted the new physician-reimbursement
policy to improve its members' access to the treatment and to encourage more
physicians in its network to initiate buprenorphine treatment.
In an interview with Psychiatric News, Doug Nemecek, M.D.,
national medical director at CBH, explained that the program was implemented
after providers told CBH that some patients had to pay out of pocket for
buprenorphine induction because the reimbursement rate for these visits was
too low, and managed care plans have no mechanism for determining compensation
for the complex and sometimes lengthy visits.
"Improving the coverage for buprenorphine use in the treatment of
opioid dependence is a welcome step forward," Eric Strain, M.D., a
professor at the Department of Psychiatry and Behavioral Sciences at Johns
Hopkins University School of Medicine and chair of APA's Council on
AddictionPsychiatry, commented to Psychiatric News. "I am very
pleased to hear that Cigna intends to increase the availability of
buprenorphine for patients, given the effectiveness of treatment for opioid
dependence."
Earlier this year, Cigna instructed its network physicians who are
authorized to prescribe buprenorphine to bill induction visits using CPT code
H0033. Three sessions are initially authorized with additional induction
visits covered upon clinical review.
Buprenorphine is a partial agonist of the mu-opioid receptor and an
antagonist of the kappa-opioid receptor. Used alone or in combination with
naltrexone, sublingual tablet formulations of buprenorphine (Subutex and
Suboxone) are approved for medication-assisted treatment for opioid
dependence. CSAT stated that buprenorphine has "maximal effects less
than those of full agonists like heroin and methadone" and"
carries a lower risk of abuse, addiction, and side effects compared to
full opioid agonists." Because of the partial agonist property,
buprenorphine also produces less severe withdrawal symptoms than full opioid
agonists.
Additional information on buprenorphine for treatment of opioid
dependence is posted at<http://buprenorphine.samhsa.gov>.▪