Medication Assisted Treatment
MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders. Research shows that when treating substance-use disorders, a combination of medication and behavioral therapies is most successful.
The Washington State Health Care Authority (HCA) recognizes five formulations of medications in the treatment of addictions: Suboxone, buprenorphine, Campral, naltrexone and Vivitrol IM. These medications must be prescribed by a physician in conjunction with state-certified chemical dependency treatment, and require a completed authorization form for Medicaid payment. Suboxone and buprenorphine may only be prescribed by a DATA 2000 waivered physician. For more information, authorization and limiting conditions, see the following links:
- DSHS HRSA Memorandum #06-75 (Revised 11/2006, Effective 10/1/06) In the HRSA Memorandum, search for Suboxone, Campral, naltrexone, or Vivitrol IM to find these medications within the memorandum.
- HCA Memorandum #11-80 buprenorphine for pregnancy and Vivitrol IM for alcohol and opiate dependence to find these medications within the memorandum.
- Medicaid Purchasing Pharmacy Information.
Physician and pharmacy reimbursements are covered under HCA through the patient’s medical Medicaid eligibility.
- For billing issues or questions, contact the MASC customer service line at 1-800-562-3022 or submit concerns by using the on-line request form at: https://fortress.wa.gov/dshs/p1contactus/.
- Physician billing Instructions for medications used in the treatment of chemical dependency can be accessed at: http://hrsa.dshs.wa.gov/download/Billing_Instructions_Webpages/Physician-Related_Services.html (see Section B-page 2 and Section H-page 9).
For questions about Medication-Assisted Treatment, email Mary.Testa-Smith@dshs.wa.gov or call 360-725-3716.
All DSHS forms can be downloaded at: http://www.dshs.wa.gov/forms/eforms.shtml or as listed below:
|1.||Suboxone Authorization — Prior Authorization Form (DSHS — 13-720) Word, PDF|
|Suboxone is used in the treatment of opioid dependence. It is a combination medication of buprenorphine and naloxone which was developed to reduce the diversion potential. This medication can be prescribed from a physician’s who has obtained a DATA 2000 waiver by the Drug Enforcement Administration and SAMHSA. The patient must be in chemical dependency treatment prior to the approval and for the duration of the medication authorization.|
|2.||Suboxone Exemption Request - Prior Authorization Form (DSHS 13-750) Word, PDF|
|The exemption requires the patient to have remained in chemical dependency treatment, has made progress in treatment, and has not taken any other opiate medications during the prior six month authorization. The other opiate medication verification is obtained through Medicaid pharmacy records and a six month medication profile from all the patient’s pharmacies. If the patient has left chemical dependency treatment or has used opiate medication(s) during the prior six months, the exemption may be denied. If the prescribing physician is aware of a unique situation where the patient need opiate medication during the authorization period, the physician should document this information and fax it to DBHR along with the exemption request. No authorization will be approved beyond the exemption period.|
|3.||Buprenorphine for Pregnancy - Prior Authorization Form (DSHS 13-901) Word, PDF (New)|
|The generic buprenorphine may be prescribed during pregnancy for an opiate addicted pregnant patient. The DATA 2000 waivered prescribing physician must:
|4.||Vivitrol IM Physician - Prior Authorization Form (DSHS 13-791) Word, PDF (New)|
|Vivitrol IM is approved for both alcohol and opiate dependency. Medicaid will reimburse for this medication under certain criteria which is attached to the prior authorization form. The patient must be enrolled in chemical dependency treatment for the full duration of the medication. This medication may only be administered in a physician’s office and is limited to six doses in 24 weeks.|
|5.||Campral Prior Authorization Form (DSHS 13-749) Word, PDF|
|6.||Naltrexone Prior Authorization Form (DSHS 13-677) Word, PDF|
|The patient must be enrolled in chemical dependency treatment for both Campral and Naltrexone. The medication is limited to one year for Campral and 12 weeks for Naltrexone.|
|For more information about these medications:|
Methadone is a synthetic opioid that blocks the effects of heroin and other prescription drugs containing opiates. Used successfully for more than 40 years, methadone has been shown to eliminate withdrawal symptoms and relieve drug cravings from heroin and prescription opiate medications. DBHR certifies 19 OTP programs in Washington State. To see if a client qualifies for OTP services, contact one of the OTP programs to schedule an appointment. See Appendix Q of the DBHR Directory.
Chemical dependency professional (CDP) may have patients that could benefit from adjunctive medication. It is important to develop a collaborative relationship with physicians who are knowledgeable about addictions, are willing and, in the case with Suboxone, able to prescribe these medications. A CDP must develop an understanding of the medical model when working with a patient who is being prescribed any type of medication. This is also true with addiction medications.
The Addiction Technology Transfer Centers in collaboration with the National Institute on Drug Abuse has developed training and technical assistance materials on Buprenorphine Treatment and the role of the substance abuse provider. The Northwest Frontier ATTC provides a 4-hour course on this material; if your agency is interested in receiving this training please contact the NFATTC training coordinator, Jennifer Verbeck, at 503-494-9611.
NFATTC’s Buprenorphine Treatment for Young Adults Blending Team designed a training package which highlights the findings of the NIDA CTN study that compared longer term versus short-term buprenorphine/naloxone treatment in an outpatient setting.
The Substance Abuse and Mental Health Service Administration’s web site on buprenorphine provides a wide era of information regarding the medication, access to Treatment Improvement Protocol (TIP 40) Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction and a variety of other related informational topics.