The need for medicare coverage of suboxone to fill a gap for those with addictions

In recent weeks, I have been approached by physicians about the critical need for covering suboxone treatment for people with addictions who are falling through a gap in present coverage.   When a person with an addiction to an opioid medication comes in to a RAAM clinic, the optimum initial treatment is to use suboxone.   The suboxone is needed immediately when they present because with addictions like this it is very important to help a person with an addiction when they are ready as opposed to when the system is ready for them.   Some people with addictions in this circumstance are covered under Employment and Income Assistance or the Indigenous Health Branch, or have the money to afford the initial treatment.   But unfortunately, some people who are destitute do not have Employment and Income Assistance even though they would be eligible for it.   The logical solution is for there to be coverage under our medicare system for these individuals so that they can receive treatment immediately, rather than having to wait days, or more likely weeks and sometimes a month or two for them to get Employment and Income Assistance.   On May 26, in Question Period, I asked the Minister responsible for mental health and addictions whether she would ensure all such individuals are covered and can receive treatment immediately instead of having to wait until they are covered by EIA.  My question and the Minister's response are below.  

Addiction Treatment at RAAM Clinics
Medi­cation Coverage for Patients

Hon. Jon Gerrard (River Heights): Madam Speaker, as I wrote to the minister, there's a need for an adjustment in the treatment for opioid 'addrictions' as now provided at RAAM clinics.

      In brief, addiction physicians are unable to start people on treatment with Suboxone or similar medi­cations imme­diately, when a person needs it, if the person doesn't have money and doesn't have the medi­cation coverage through EIA and IHB or private insurance.

      Since addiction treatment needs to be started as soon as a person is ready and can then imme­diately reduce the risk of overdose, the impact of the therapy would be much better if the gov­ern­ment would cover six months of opioid agonist therapy for such individuals.

      Will the gov­ern­ment consider this life-saving measure?

Hon. Sarah Guillemard (Minister of Mental Health and Community Wellness): Our gov­ern­ment has made major invest­ments into mental health and addictions over the last few years, and a number of those initiatives have saved lives. We will continue to invest in the data-driven treatment to help Manitobans address their addictions issues.

      I'd be happy to sit down with the member oppo­site and further discuss some of our harm reductions and our treatment options that we are offering to Manitobans.

      Thank you.

On May 27th in Estimates I followed this issue up.  Below is my question and the Minister of Health's response:

Mr. Gerrard: My second question relates to the coverage of Suboxone. Now, this deals with a question which I raised in the Legislature yesterday in question period.

      One of the major problems in treating people with addiction is that they need to be treated when they are ready to be treated. One of the problems that people in–physicians in the RAAM clinics are finding is that people who come in for addictions treatment are often, you know, whether they were rich busi­nessmen or whether they were–had been homeless people before, are in a des­per­ate situation. They've exhausted their money; they're not on EIA or other–have no insurance coverage, and so they need to be started right away on Suboxone,

      And so it really is critical that there be an option for people who don't have other coverage for the Suboxone or other compound which is similar to be used and to be covered under medicare. I think the Pharma­care program falls under the minister's pur­view and I would just ask the minister to take this con­cern very seriously and she what she can do.

Ms. Gordon: Hi there–oh, sorry–thank you, Mr. Chairperson.

      I do want to just clarify that the Pharma­care pro­gram is a uni­ver­sal, income-tested program. So it means that the–an individual–individuals with the least ability to pay pay the lowest deductible. Likewise, an individual with the greatest ability to pay pays the highest deductible. Those who have no ability to pay are supported through the De­part­ment of Families income assist­ance–Em­ploy­ment and Income Assist­ance Program. So, this is to ensure that no one falls through the cracks.

      And I also want to share with the member that in this room, after the De­part­ment of Health Com­mit­tee of Supply and Estimates has concluded, Mental Health and Com­mu­nity Wellness will follow, if the member so chooses to bring that forward, in terms of Suboxone, to that minister. The Min­is­try of Families is–will–is also in room 255. That can be brought for­ward, in terms of EIA supports.

      Thank you, Mr. Chairperson.

Mr. Gerrard: Yes, the problem, in terms of EIA, is that it may take several weeks to come into effect, and–so that the Suboxone is not imme­diately available for people who need it for addictions treatment if the  person is not on EIA, which unfor­tunately does happen.