Drug treatment put at $80 million
A state audit shows that taxpayers shelled out nearly $50 million in 2009 to supply methadone to thousands of people on public assistance and more than $32 million to transport them to clinics.
The 91-page review released this month by the Legislative Budget and Finance Committee stemmed from a resolution passed in the state Senate last summer. Its purpose was to determine the cost to dispense methadone statewide and to transport patients to clinics, as lawmakers looked to trim program expenses.
The audit examined the length of time patients use the synthetic drug, which is used to treat addiction to heroin, oxycodone and other opiates.
The audit found taxpayers spent $48.8 million in 2009 -- excluding transportation costs -- to provide the drug to 18,884 Pennsylvanians on Medicaid.
An additional $32.5 million was spent to transport methadone users to clinics during fiscal 2009-10, which runs from July to June, according to the report.
State Sen. Kim Ward, a Hempfield Republican who sponsored the Senate resolution, said the methadone costs are too high, even it they represent only a small portion of the state's overall Medicaid costs.
"The fact that Pennsylvania is spending over $80 million a year on methadone clients is unfathomable," Ward said. "The state's (budget) deficit is over $4 billion. Funding for essential programs such as ... food banks are being cut, but the amount we spend on methadone is increased."
Ward said one of her bills seeks to ensure that all methadone recipients on public assistance go to the nearest state-approved methadone clinic. The audit estimates potential savings of up to $2 million if that occurred. Until a recent policy change by the state Department of Welfare, no such restriction on travel was in place.
"We pay for this," Ward said. "We're going to spend the least amount possible. We don't have (limitless) money in our budget. I think it needs to be the closest state-approved clinic."
Ward noted that methadone transportation costs increased by 26 percent between 2007-08 and 2009-10 -- from about $25 million to $32 million.
Federal regulations require states to ensure that transportation is available to Medicaid recipients to and from clinics, the audit notes.
The review points out that when the Welfare Department recently restricted mileage reimbursements to the closest or next closest clinic, the estimated savings was $1.3 million. An additional cost savings of about $500,000 was projected if reimbursement were limited to the closest clinic, the audit says,
The study found the average time a state Medicaid client is on methadone is 27.3 months. But that number is based on responses from only 33 of 61 clinics, according to the audit.
"The legislative reference bureau did the best job they could ... but the fact is that many clinics refused to respond to their request for information," Ward said.
s of June, 58 methadone clinics operated in the state, including eight in Allegheny County, three in Westmoreland and one in Fayette.
Tom Plaitano, an attorney who owns Medtech Rehabilitation, a Hempfield clinic where 400 people receive methadone daily, said he agrees with Ward that reforms in the program are needed -- especially in transportation. But his primary solution is to have more clinics.
"There are 67 counties, and there's only 28 counties that actually have clinics," Plaitano said.
The audit showed that counties without methadone clinics had transportation costs four to five times the amount spent in counties with clinics, he said.
Methadone remains the best way to treat opioid addicts, Plaitano said.
Ward believes there is a direct relationship between criticism of the methadone transportation program and the Welfare Department's recent decision to limit travel.
"I know that's what happened," she said.
Michael Race, spokesman for the department, denied that Ward's questioning prompted the changes, saying the Welfare Department was looking at revisions as early as 2009, spurred by Sen. Don White, an Indiana Republican.
His agency agrees with most of the audit's determinations, Race said, and plans to incorporate many of the findings into guidelines to be forwarded to providers and others.
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