May 12, Wisconsin Health News
The state added an additional opioid-addiction treatment to its preferred list for Medicaid patients Wednesday, after law enforcement and legislators raised concerns about a current preferred drug that they say is being smuggled into jails.
The Medicaid Pharmacy Prior Authorization Advisory Committee classified the medication Zubsolv, which comes in a tablet, as a preferred drug for treating opioids. The committee also kept Suboxone, a film strip that dissolves under the tongue, on its preferred list.
In April, two associations representing sheriffs in Wisconsin wrote Medicaid Director Michael Heifetz that the "thin and malleable" strips have become "leading contraband" in jail, as inmates can abuse the drug. The associations suspected Medicaid-eligible families were "partially responsible" given jail demographics.
Rachel Currans-Henry, director of the Bureau of Benefits Management in the department's Division of Medicaid Services, said Wednesday that adding Zubsolv gives providers and members another option.
"There is an increased cost of this for the department," she said. "But in the interest of ensuring that we are addressing a public health epidemic in the state and the country, we believe that the benefits outweigh the costs."
Heifetz said they have "to balance all these things."
"We cannot just look through one lens," he said. "We have to look through a number of lenses, the taxpayer lens, the clinical lens and in this situation the law enforcement lens as well, which is a rarity for us."
Marquette County Sheriff Kim Gaffney, president of the Badger State Sheriffs' Association, hoped the decision would make a difference.
"On behalf of sheriffs across the state, we are hopeful that more opioid treatment options in the Medicaid program will reduce the prevalence of film strips and them being smuggled into jails," he said in a statement.
At a public hearing before the committee took its vote, Assembly Committee on Corrections Chair Mike Schraa, R-Oshkosh, demonstrated how the strip could be concealed under a stamp.
The strip is easier to "sneak into" jails than pills, cigarettes and other contraband, sometimes coming in through children's artwork or Bibles, he said.
"There's no good reason for the government to fuel the black market with this product," he said.
He was also concerned because Wisconsin Attorney General Brad Schimel has joined more than 40 other states to sue Indivior, the maker of Suboxone, alleging that the company switched from a tablet to a film to ensure patent protection and discourage the development of generics.
William Mullen, managed care clinical advisor for medical affairs at Indivior, encouraged the committee to "open the formulary for all" medication-assisted treatments approved by the Food and Drug Administration for opioid addiction.
That would allow doctors to choose what works best for their patients, he said. But Mullen cautioned that all drugs that contain buprenorphine, like Suboxone and Zubsolv, have a potential for abuse, misuse and diversion.
"The company will continue work with the FDA to address misuse, abuse and diversion," he said.