A once-a-month injection of Vivitrol, a drug administered to quash cravings, costs more than $1,000 a shot. Outpatient detox runs $1,000 to $1,500. And 90 days in a high-end inpatient drug rehab program can cost as much as a year at an Ivy League university, putting it well out of reach for all but the wealthiest Ohio families.
Ohio is in the grips of a deadly opiate crisis that is gaining steam — and expense.
Medicaid, a state and federally funded health care program for more than 3 million low-income and disabled Ohioans, is paying the biggest share of the bill when it comes to the opiate crisis.
Just three years ago, in 2014, Ohio Medicaid paid out $59.3 million for medications used to treat opioid addiction, such as Suboxone, Buprenorphin, Naloxone and Vivitrol. In 2016, the tab hit $126.6 million – 113.5 percent increase.
The cost for group counseling, outpatient programs, detoxification and other services for alcohol and other drug addiction was $100.3 million, according to the Ohio Department of Medicaid. By 2016, it soared to $216.5 million.
Ohio was among 31 states that expanded Medicaid to cover more low-income people through the Affordable Care Act, also known as Obamacare. Expansion in 2014 led to an additional 715,000 signing up for Ohio Medicaid, nearly one-third of whom suffer from drug abuse issues.
Roughly 112,000 Ohioans sought publicly funded treatment for alcohol or other drug addiction, 47 percent of whom had opiate addictions. (That figure doesn’t include people seeking treatment through private insurance plans or cash payments.)
Debate in Washington, D.C. and the Ohio Statehouse is now raging over whether to repeal Obamacare and institute cuts and reforms to Medicaid.
“I think sustaining the Medicaid expansion in Ohio is going to be really important in order to continue to be able to connect people to treatment, both for their immediate withdrawal and beginning stages of treatment but then also for the longer term if they need ongoing counseling or therapy or just access to primary care to help them continue productively as Ohio residents,” said Tracy Plouck, director of the Ohio Department of Mental Health and Addiction Services.
Under the expanded program, Ohioans making less than 133 percent of the federal poverty level, which is $32,718 a year for a family of four, are eligible for Medicaid. Without Medicaid, many would have to scramble for assistance with drug treatment costs elsewhere. Or forgo treatment.
“There is no substitute for Medicaid. There is no huge source of money that is going to be available to supplant it,” said Dr. Joshua Sharfstein, associate dean of public health at Johns Hopkins University. “I think this is important for anyone that wants to help on addiction to take a clear-eyed, non-ideological, evidence-based look. What is it that is providing treatment that can save people’s lives? Bottom line is it’s Medicaid.”
A 60 to 90 day stay in an inpatient rehab program runs $12,000 to $60,000 while outpatient counseling runs $5,000 to $10,000 for a three-month course, according to national data from AddictionCenter.com. A year of methadone maintenance — a drug used to quash cravings for heroin — runs about $4,700.
Experts note that when Medicaid or other public institutions are paying the bill, the negotiated rates are on the lower end of the spectrum.
Plouck said Ohioans seeking treatment should look for providers who are certified by the state. While some providers put up billboards promising resort-like services, Plouck said “We don’t believe it is necessary to pay $60,000 to connect with meaningful and appropriate treatment in the state of Ohio.”
‘They’re panicking — and rightly so’
Lost in the debate over Medicaid expansion is the fact that Ohioans with private insurance plans are sometimes denied coverage for drug treatment. Some denials may be in violation of a federal law in place since 2009 that bars health plans from charging more in co-pays, deductibles or other fees for mental health and drug addiction coverage than they do for physical health coverage. In wonky shorthand, it’s called “parity.”
“There are people who are second-mortgaging their homes or dipping into retirement funds because they’re panicking — and rightly so,” said Lori Criss, associate director of The Ohio Council of Behavioral Health & Family Services Providers.
Ohio and other states have been slow to enforce the parity requirement, making it harder for families affected by the opiate crisis, according to Susan Ackerman, director of the Joint Medicaid Oversight Committee.
The state budget bill now pending in the Ohio Senate includes a provision that would require the state departments of insurance and mental health and addiction services to run a consumer hotline to help Ohioans navigate coverage and develop education materials for both consumers and insurance plans on the parity requirements.
“I think there certainly is opportunity for us to do more education and outreach to Ohioans generally about how to seek treatment and how to discern what treatment is covered by your health plan or health insurer,” Plouck said.
Other states, however, have actively investigated whether health plans are following the law, said Tim Clement, senior policy advisor, the Kennedy Forum, a national group founded by former Congressman Patrick Kennedy. California’s health management department and New York’s attorney general have both investigated whether insurers are following the law while 20 other states recently applied for federal grants to pay for such investigations and analysis, he said.
Ohio isn’t among them.
The Ohio Department of Insurance website does provide info on the federal mandate and contact numbers for consumers and companies but it takes some effort to find it.
“I’d give it a C-minus to a D-plus,” said Terry Russell, executive director of the National Alliance on Mental Illness Ohio. “They haven’t done a decent job with that. Too many people are not getting the benefits that they’re paying for.”
Department of Insurance spokesman Chris Brock said the state has received just 18 complaints over three years about parity.
“In our experience there are not systemic problems based on our initial reviews and the subsequent complaints we have received,,” said Ohio Department of Insurance spokesman Chris Brock. “This is a complex issue that is not easy to understand. Often, the law is misunderstood by consumers who believe it to require more than it actually does. However, when there is a violation, the department takes appropriate action.”
Ohio Lt. Gov. Mary Taylor, who led the state insurance department for more than six years, recently talked with the Dayton Daily News about her own family’s experience with drug addiction.
While the cost of treatment can be steep, the cost of going without it can be worse.
More than 21,000 Ohioans have died of accidental drug overdoses in the past 10 years. Despite investing almost $1 billion a year to fight drug abuse and addiction, accidental overdoses claimed 3,050 lives in Ohio in 2015, up 20.5 percent over 2014. Preliminary data from the Ohio Department of Health shows 3,835 fatalities in 2016 — a 25.7 percent hike over 2015.
Ohio tightened up opiate prescribing guidelines, expanded Medicaid so more people have access to treatment, deployed Naloxone — a drug that reverses an overdose — and is pushing preventative measures. Still, Plouck said it isn’t enough to turn the tide just yet.
“I think we will see the number of deaths increase before we see a decrease there,” she said.
OHIO’S OPIOID CRISIS
* The opioid addiction crisis gripping Ohio is alarming state leaders. Here are some crucial numbers:
* Unintentional drug overdoses since 2007: 21,003
* Number of people seeking treatment for opiate addiction: at least 53,000
* Ohio Medicaid cost in 2016 for medication to treat addiction: $126.6 million
* Ohio Medicaid cost in 2016 for drug counseling and other services: $216.5 million
For assistance in finding drug treatment in Ohio, call (877) 275-6365.
Ohio also has a 24/7 crisis text line: Text keyword “4HOPE” to 741 741