Having spent tens of millions of dollars drug testing people in addiction treatment for the past two years, Maryland Medicaid officials banned the most expensive screenings after determining they were unnecessary.
Such drug screens are used to determine whether patients are misusing legal or illegal drugs or taking medications properly. Such tests can screen for a single drug, a handful or a wide variety of drugs in someone’s system.
State Medicaid officials decided late last year that tests screening for a large number of drugs, costing up to $171.10 each, are “not medically necessary” for addiction treatment providers. The ban took effect at the beginning of 2018.
The decision came after such screenings were on pace to consume about 23 percent of the $315 million the state Medicaid program spent last year for substance use treatment, according to figures provided to The Baltimore Sun. That’s more than the program spent on basic outpatient treatment.
The government health program for the poor, which covers a disproportionate number of people with addictions, still allows screening for smaller drug groups and anticipates at least $6 million in annual savings as providers switch tests under the new policy. Screening for a smaller group of drugs can cost as little as $63.55 per test.
Many providers and laboratories were billing Medicaid for the more expansive and expensive drug tests.
“This is a widespread issue across the field,” said Nikki Laska, a spokeswoman for the state Department of Health, which oversees Medicaid.
Observers say other state Medicaid programs, as well as private insurers, have sought to curb expensive tests, but it’s not clear any have blocked them without exceptions. Federal Medicaid regulators didn’t respond to questions.
Some addiction treatment providers say they would like to use larger tests occasionally because of the wide range of drugs available. State health department data shows that most people who now fatally overdose have taken more than one kind of drug.
Dr. Sunil Khushalani, a treatment provider in the Towson-based Sheppard Pratt Health System, got the Medicaid memo and said the state’s guidance is largely appropriate. Though, he said providers might sometimes have a case for broader testing.
“I think more than just overuse they are trying to eliminate unnecessary testing and that is important,” he said. “They could allow it on a case-by-case basis if a clinician appeals this, if the clinician is able to provide justification. But providers and programs should not be routinely ordering simultaneous definitive screenings for 14 drug classifications.”
Relying at least initially on more simple tests and other monitoring tools follows guidelines issued last year by the American Society of Addiction Medicine. The guidelines don’t call for a ban on large panels, but they recommend providers consider costs when ordering tests because of the burden on taxpayers, insurers and even patients.
“These concerns about really inappropriate use of very expensive testing is a big reason ASAM chose to create the document on drug testing,” said Dr. Margaret Jarvis, the association’s board vice president and chief of addiction medicine for the Pennsylvania-based Geisinger medical system.
She attributed the over-testing to a lack of provider training. However, she added, “there is a lot of untoward business going on because there is money to be made. It’s a sad statement but there we are.”
Jarvis said the guidelines call for more use of less definitive in-office tests and “judicious” use of lab tests for specific information. For example, panels of more than 14 or 22 drugs, the two tests banned in Maryland, could inform treatment by revealing if someone who was misusing oxycodone has started using other prescription opioids and which ones.
Jarvis said doctors also should rely on interviews with patients and family, behavioral observations and knowledge of the local drug scene to determine how people are faring on treatment.
She said she thinks most providers, when faced with the ban, “will say I can live with that.”