Patient cap being lifted?

Buprenorphine Post
Posts: 198

Postby NoDrugs4u » Mon Sep 21, 2015 9:25 am

Heaven help us if they pass the bill which allows NP's and PA's to prescribe bup. The quality of care will plummet, like it has in other areas of medicine where they are allowed to practice.

Posts: 49

Postby Bruni » Mon Sep 21, 2015 9:25 am

The Proposed Rule as published by HHS in the Federal Register today to open the 60 day public comment period:
Medication-Assisted-Treatment for Opioid Use Disorders


Posts: 180

Postby entjwb » Mon Sep 21, 2015 9:25 am

Dr Paser, this may not affect everyone. There are stipulated conditions about who will be granted an increase and you will have to apply to get approved.

Posts: 1404

Postby drpasser » Mon Sep 21, 2015 9:25 am

It is happening.
Today should be the announcement to raise the cap to 200 pts!


Posts: 571

Postby kcairns » Mon Sep 21, 2015 9:25 am

plus see huff post today 2 great articles look quick before they go, both fascinating

Posts: 571

Postby kcairns » Mon Sep 21, 2015 9:25 am

google 2016 opioid summit 3/28-31. Obama speaks today

Posts: 90

Postby rickbennettmd » Mon Sep 21, 2015 9:25 am

Current status?

I was recently apprised of the situation regarding increasing patient limits by an upper officer of the lab corporation that we use. She presented this information with full authority, not presenting it as rumor or hearsay.

Yet this is information from one person, of course.

She told me that the federal bill to increase patient limit to 250 is to be considered by congress in April. If passed this will be instituted in May. The plan is to apply this to all waivered providers for an initial period of two years

Does anyone else have more current information that they are aware of by their particular sources?

Richard Bennett

Posts: 118

Postby sslonim » Mon Sep 21, 2015 9:25 am

key part:
A Senate committee on Wednesday unanimously passed an amendment that would greatly increase access to buprenorphine to treat opioid addiction, according to The Huffington Post.
The amendment was sponsored by Senators Edward Markey of Massachusetts and Rand Paul of Kentucky. Under current federal rules, doctors who are certified to prescribe buprenorphine (sold as Suboxone) are allowed to write prescriptions for up to 30 patients initially. After one year, they can request authorization to prescribe up to a maximum of 100 patients.
The amendment would increase patient limits to as many as 500, and allow qualified nurse practitioners and physician****istants to prescribe buprenorphine, the article notes.

Posts: 571

Postby kcairns » Mon Sep 21, 2015 9:25 am

Only evidence/data I have that is not available to all for the digging is - in MTD/BUP OTP where I do some of my work, cost for corporate to deliver whole good package to client = $65/week for mtd and $110 for bn up to 12 mg/d and many clients in and out of rx based on having or not, at any given moment, the cash, and for lots of people the difference between 65 and 110 is "much"

When I travel by air, I would much prefer to go first class but coach gets me to my destination (ie who wouldn't prefer bup in well appointed office to sitting in straight chairs lined along the wall.)

) The oil and heroin rush ciy of Minot ND d/t negative feelings has held off for a year an effort to set up OTP there.

There are reports of relative safety of bn/mtd maintenance in OTP setting, but also overall improved survival data which are out there I believe show 50-75 % decreased mortality w either one vs no medication.

I like the idea of we each focus on making our care of our own patients seamless and would love to see a thread on what constitutes such and we on front lines are only ones who know that tho even among our board colleagues there is lots of difference.

I wanted to raise suggestion that overall seamless care to a society cannot be even conceived outside the reality of financial accessibility. Is it the peoples' fault because they chose to spend all their money on drugs and now have no money left? Is it just that the population I see is more socioeconomically compromised than the average? What can I say to those patients who did not start recreationally but during the push of jcaho and fsmb and big pharma that COT was safe and effective for chronic pain and we docs had better work on that fifth vital sign and oxycontin-up those faces into big happy smiles or else? I am now seeing a fine older man off from my appt and dosing here to work in the snow 2 miles past the end of the road this wintry day in these mountains , he not complaining a bit about his plight but thankful he can come up with the $60/week for methadone maintenance as he could not a penny more and be able to do it rather than be sick in bed. On Friday a woman w 4 kids told me of her struggle to find a "place " for them ..she didn't even speak the word "home". just a "place", and ditto for her re methadone maintenance . I wish I were a rich man. I wish I could do my responsibility to my my 17 yo daughter and son to get them through enough schooling to not have things so hard for themselves. I wish I could remember how Freud avoided worrying about such things.

Posts: 104

Postby jmosby1469 » Mon Sep 21, 2015 9:25 am

In the case of my recent methadone transitioning patient, the lack of availability of Medicare/Medicaid coverage for methadone clinic charges may be the cause, but it is probably more than that.

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