By Taylor Knopf

Despite the escalating problem of opioid abuse and overdoses across North Carolina, there is only one “preferred” addiction treatment under the state Medicaid program.

If a provider would like to treat a Medicaid patient with a treatment other than Suboxone® SL Film, they must go through extra steps that could take as little as a few hours or as much as days to receive approval through the North Carolina Medicaid Program.

North Carolina physicians and counselors are asking a committee that meets under the state Department of Health and Human Services to eliminate the prior authorization requirement for non-preferred drugs so they can provide any medication-assisted treatment to patients immediately.

“Prior authorization comes through quickly sometimes, other times it takes 72 hours,” said John Woodyear, president of the Old North State Medical Society.

“It’s hard to predict how quickly we will get authorization. Many times a patient that comes to the office is going through withdrawal, and they want to start immediately,” Woodyear said.

He compared going through opioid withdrawal with the feeling of drowning. “It’s like telling someone who is drowning, ‘I see you, and I can help. Just wait 72 hours and I’ll send a life raft.’ You have to strike when the iron is hot.”

Woodyear added that providers have many preferred treatment options for diabetes and high blood pressure under the the state’s Medicaid Program. He doesn’t understand the rationale behind only one option to treat addiction.

shows orange Suboxone pills
Suboxone is available in a film placed under the tongue or in a pill form. Before prescribing either form, physicians have to take special training. Photo courtesy: Soberconnections/ Wikimedia Creative Commons

On behalf of his medical society, which represents African-American physicians, Woodyear sent a letter to Gov. Roy Cooper and DHHS Secretary Mandy Cohen asking for the elimination of prior authorization for all buprenorphine/naloxone products for Medicaid patients.


“During a public health emergency, providing only a single preferred product to address an epidemic is inadequate,” Woodyear wrote.

“We know that we can do better for our Medicaid patients and seek your leadership to remove these unnecessary barriers that tax our office’s resources and makes access to these life-saving medications more challenging.”

A group of more than 50 counselors and other caregivers in North Carolina also signed a letter addressed to the committee that decides which medications are preferred under Medicaid. They also are asking for the elimination of prior authorizations for addiction treatments.

“As non-physician health care providers serving Medicaid recipients in the state, we respectfully request that this committee take the lead in addressing the opioid crisis by voting to cover all buprenorphine/naloxone products at your next meeting,” reads the letter written on University Psychiatric Associates letterhead.

Asking a patient to wait for prior authorization of a treatment that is best for them is “not practical or fair,” the letter reads.


“These delays endanger patients to relapse, potentially impacting the individual, their family, employer, even the criminal justice system,” the letter continues.

Kelly Haight, DHHS press assistant, said Suboxone is the preferred treatment “because the Pharmacy & Therapeutics Committee, Physicians Advisory Group and Prescription Drug List Review Panel agreed that the naloxone/buprenorphine products in that drug class are equivalent in clinical efficacy and safety.”

“Additionally, an analysis of prior authorization request reported equal access to all three buprenorphine/naloxone products regardless of their status on the Preferred Drug List. After conducting a financial review, the North Carolina Medicaid Pharmacy Program determined that Suboxone provided the best value to beneficiaries and providers,” Haight added.

Compelling physicians to seek prior authorization for Medicaid treatments is not unusual. This past week, North Carolina Medicaid just required physicians to seek prior authorization to prescribe opioids for more than two weeks and above a certain dosage.

Few doctors prescribing treatment

Providing physicians with immediate access to all addiction treatment for their Medicaid patients is only one part of the equation. There also needs to be more doctors who can treat people with addiction.

Woodyear said he is also urging members of his society to become federally certified to treat patients with opioid addiction. Woodyear, who is a family doctor from Troy, N.C., is treating around 275 patients per month with opioid addiction and could be seeing even more.

“There are so many people writing prescriptions of the controlled substance, but very few waivered to provide addiction treatment,” Woodyear said. “There is still a bias in the profession. They don’t want to be involved with ‘those people,’ yet they are contributing to the problem those people have.”

Fewer than 1 percent of North Carolina prescribers are certified to administer medication assisted treatment for opioid addiction.

According to the North Carolina Medical Board, there were 26,295 physicians and 5,788 physician assistants registered with the board in 2016. While they are all licensed to prescribe opioids, only 190 are certified by the federal Drug Enforcement Agency to prescribe addiction treatment medication.

Lawsuit over addiction treatment drugs

Meanwhile, North Carolina and 35 other states have sued the company that makes Suboxone Film, the only North Carolina Medicaid preferred drug to treat opioid addiction.

Last September, then-Attorney General Roy Cooper announced an antitrust lawsuit against Reckitt Benckiser Pharmaceuticals, now known as Indivior, alleging that the company blocked generic versions of the drug to keep the price unlawfully high.

“Gaming the system to charge higher prices on needed medications is wrong,” Cooper said in a press release at the time. “Prescription drug abuse is a serious problem in North Carolina and those trying to recover from it suffer if artificially high costs make it harder for them to get treatment.”

“The attorneys general allege that their investigation shows consumers and other purchasers such as local law enforcement and emergency medical services paid artificially high prices for Suboxone since late 2009, when generic alternatives would have become available without the illegal interference,” the press release reads. “During that time, annual sales of Suboxone topped $1 billion.”

The lawsuit alleges that the maker of Suboxone conspired with another company to change the drug from a tablet form to a film that dissolves in the mouth. The lawsuit claims that this was done “to prevent or delay generic alternatives and maintain monopoly profits.”

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Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...