Mind and Body

Catch 22 emerges with providers buying naloxone

There apparently is no existing billing mechanism to be reimbursed for purchases for the overdose reversal medication

Image courtesy of the R.I. Department of Health

The Providence Safe Stations initiative is planning to step up its outreach efforts, using this as a postcard.

By Richard Asinof
Posted 4/16/18
Providers are required to dispense naloxone, but there is no billing mechanism for them to be reimbursed for the purchase of the overdose reversal medication. A group that includes Sen. Josh Miller is exploring ways to find a solution, perhaps through legislation.
Because the problem may require changes in federal Medicaid rules and regulations, is there a way for the Rhode Island Congressional delegation to become involved? Is this problem a topic that should be addressed by the Task Force at an upcoming meeting? Can the health insurance companies create a unified response to address this problem? Is there a way to protect both consumers and providers from the apparent price gouging by manufacturers of naloxone, following the declaration by the U.S. Surgeon General that everyone should be carrying it.
Last week, the Northeastern University School of Law hosted its annual health law conference, entitled: “Diseases of Despair: The Role of Policy and Law.” The conference explored potential political, policy and legal responses for addressing the broader determinants that affect the physical and mental health of Americans dying from diseases of despair. Among the participants were sociologist Shannon Monnat and Elizabeth Tobin-Tyler, associate professor of Family Medicine at the Warren Alpert Medical School.
What would it take for the School of Public Health at Brown University, in conjunction with Roger Williams University, to convene a similar conference, perhaps including gun violence and domestic violence as part of the mix of topics? Why not call it “At the Intersection of Hope and Violence?”

PROVIDENCE – Sometimes what is said after the meeting of the Governor’s Task Force on Overdose Prevention and Intervention in conversations among members is just as important as what gets said during the meetings.

Take, for instance, what happened after the April 11 meeting of the Task Force, when there were a number of conversations about what to do about apparent problems in reimbursement regarding dispensing naloxone at community health centers and emergency departments.

Although there are health department regulations requiring the distribution of naloxone, there is currently no mechanism for providers to be reimbursed for the purchase of the overdose reversal medication.

As Susan Jacobsen, director of Health Equity Initiatives at Thundermist Health Center, explained it to ConvergenceRI, there is an existing recommendation that providers distribute Narcan at the point of care, at an appointment, particularly to folks who may be at a high risk of an overdose.

The problem, she continued, is that there is currently no billing mechanism that allows providers to bill for that. “We don’t have any way to be reimbursed for the naloxone we buy,” she said.

Jacobsen and others have been in conversations with Sen. Joshua Miller, also a member of the Task Force, and they are looking at potential solutions to the problem.

“We are not really sure, at this point, if the problem can be resolved by legislation, if it can be resolved through an amendment to the rules and regulations, or if it needs both of those things,” she said.

Jacobsen continued: “We are not sure if that might need to include, at least for Medicaid, for some federal rule or regulation that needs to be addressed.”

Clarity and consensus
Ian Knowles, program director at RICARES, confirmed with ConvergenceRI that there was a lack of clarity around naloxone purchases and existing billing codes. “Insurance doesn’t cover naloxone when it is distributed from an emergency department or from a health center,” Knowles explained. The providers, he continued, would have to pay for the medication up front, and then getting reimbursed for it is “iffy.”

Knowles described the apparent Catch-22 as follows: “If a health center wanted to purchase a stash of naloxone, they could, but they would have to pay for it themselves,” he said. “I’m not sure if they could ultimately be reimbursed through insurance once it is dispensed.”

Knowles confirmed that he had heard that Thundermist and others are trying to figure out a way to purchase naloxone with insurance companies covering the cost up front, and the group has been conferring with Sen. Miller about potential legislation to do that.

Reports from the front
The April 11 meeting of the Task Force was chock full of reports from the front:

The creation of what is known as BH Link by the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, to help fill in the gaps in the current behavioral health care system by providing a hotline and triage center to respond to those individuals experiencing a behavioral health crisis, as well as connecting people to treatment and recovery resources, with the goal of preventing unnecessary emergency services transports to emergency rooms.

A report on the progress of the Providence Safe Stations initiative by Chief Zachariah Kenyon of the Providence Fire Department, who asked task force members to help get the word out about the program. Since its launch in January, there have been 10 cases.

Amy Ferguson described her experience as a naloxone lay responder, injecting someone who had overdosed and saving his life.

A report by Michelle Harter on the Burrillville Addiction Assistance Program, a new, non-clinical, peer-to-peer initiative to build a bridge between Burrillville residents and addiction treatment and recovery services.

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