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Virginia drug treatment center fears effects of insurance barriers

The Manassas Addiction Center owner says it took unpaid hours to get an insurance company to cover a medication used for treatment.

MANASSAS, Va. — Manassas Addiction Center may offer treatment services to anyone but the number of children coming in throughout the DMV is causing alarm, amid the need for more resources to treat addiction.

However, there are concerns about what insurance barriers could mean in the long run amid reports of youth overdoses.

Family nurse practitioner Nancy Sadler said the clinic treats about 30 patients every day. Another provider in the clinic said at least 50% of his patients are adolescents. One of the youngest patients to come through the door was 12 years old, who first started abusing the highly potent synthetic opioid fentanyl.

Sadler said the practice is the first to provide outpatient drug treatment services to youth in the area. However, she said there are still not enough resources or clinics offering the same outpatient service to children. In some cases, fear of treating kids so young may play a role.

“I think there’s probably a large untapped source of patients that we’re just not treating because we’re not seeing them,” Sadler told WUSA9. “There’s nothing worse than holding a parent’s hand and say how sorry you are that they lose their child.”

The clinic provides Vivitrol or Naltrexone to children, a once-a-month injection that helps prevent the effects of narcotics, synthetic or natural, from affecting the brain.

Mohamed Coly brought his 16-year-old son to the center for treatment after a court order. He said Vivitrol is already proving to be effective.

“The drug has helped him a lot,” Coly said. “Since the drug was administered, I started feeling some confidence that I could leave him alone. His facial expression is good and his respect to his parents returned again.”

However, Coly complained about how difficult it was for his insurance company to cover the costs of Vivitrol. He claimed the prescription for the medicine was passed from pharmacy to pharmacy while it was unclear if it was covered. Phone call attempts led nowhere to the point where he considered paying the $1,600 out-of-pocket cost.

“It’s extremely difficult,” Coly added.

It wasn’t until Sadler stepped in that Coly’s son was able to receive Vivitrol. Sadler says Vivitrol, which is off-label for adolescents, is normally accepted by Medicaid but it’s a different story with private insurance companies.

Specifically, she recently dealt with one major insurance provider.

“Just in the last two months with two patients, I’ve spent 20 unpaid hours on the phone trying to get Vivitrol and I haven’t accepted a no so far,” she said. “I was being shut down, so I went through 12 different representatives and decided to email the CEO. The medical side would say we want you to buy and bill this medication but at that time, there were seven visits completely unpaid.”

Sadler also claimed there are delays in claims getting paid.

She urges insurance providers to make access to these types of medication easier.

“It’s not just in our community and schools, now we have to fight insurance companies to allocate the treatment they need,” Sadler said.

Recent data from the Virginia Department of Health shows out of nearly 2,500 drug overdose deaths in 2022, almost 80% involved fentanyl. If you count other synthetic opioids, that’s about $2,000.

There was a spike in the middle of the pandemic but since 2018, there’s been an increase when the death rate was just under 800.

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