According to the California Society of Addiction Medicine, Medi-Cal has decided to help patients with opioid substance abuse disorder get buprenorphine products like Suboxone.
A Treatment Authorization Request (TAR) for most buprenorphine products like Suboxone is no longer required by Medi-Cal, providing greater time management options for both Medi-Cal recipients and their doctors. This reform will make it much easier for patients to get Suboxone prescriptions filled in a timely manner.
Both a Drug Enforcement Administration waiver and a diagnosis of opioid addiction are still required, but these can be quickly obtained when the drug is prescribed. There remains a maximum of 120 units and a 30-day supply of the drugs.
A TAR for Medi-Cal patients is necessary to receive certain kinds of healthcare services from medical, pharmacy, or dental providers enrolled in the program. Providers must receive authorization from Medi-Cal in order to provide and/or be paid for some of these services.
As the California Department of Healthcare Services explains, “TARs are used by Medi-Cal to help ensure that necessary medical, pharmacy, or dental services are provided to Medi-Cal recipients and that providers are reimbursed appropriately.” When it came to buprenorphine products like Suboxone, the issue was less about reimbursement and more of an example of the ongoing resistance to medication-assisted treatment for opioid substance abuse disorder.
The problem with TAR was the delays that go hand-in-hand with government bureaucracy and the stopgap in treatment as a result of such delays. When a Medi-Cal recipient is willing to take the step to access treatment for the disease of addiction, such willingness needs to be responded to quickly with a doctor’s ability to judge trusted by the state. The removal of the requirement of TARs for the prescribing of buprenorphine products like Suboxone is a step in the right direction.