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Quantum Units Education

Medicaid Coverage for Medication-Assisted Treatment of Alcohol and Opioid Use Disorder

Executive Summary

1. Which of the following is an effective medication used to reverse opioid overdose?

A. Methadone

B. Buprenorphine

C. Naloxone

D. Acamprosate


2. All states reimburse for buprenorphine, buprenorphine-naloxone, oral naltrexone, extended-release naltrexone, disulfiram, acamprosate, and methadone as medication-assisted treatment.

A. True

B. False


3. Reimbursement of medications as MAT means that they have preferred status within state Medicaid programs.

A. True

B. False


4. Most prior authorization requirements for buprenorphine monotherapy exist because:

A. It is not available in generic form, making it more expensive.

B. Of its potential for abuse.

C. Patients must abstain from opioids for a minimum of 7 days prior to receiving treatment.

D. It requires that the patient be stabilized on other medications before use.


5. Lifetime treatment limits are disappearing, which is consistent with clinical evidence and best practices, given that addiction is a chronic disease.

A. True

B. False


Introduction

6. Addiction is:

A. Chronic

B. A brain disease

C. Characterized by compulsive drug or alcohol seeking and use despite harmful consequences

D. Addiction is a chronic, relapsing brain disease that is characterized by compulsive drug or alcohol seeking and use despite harmful consequences


7. According to research that tracks individuals in treatment over extended periods, most people who get into and remain in treatment do all of the following, except:

A. Decrease their risk of heart attack and/or stroke.

B. Stop using drugs.

C. Decrease their criminal activity.

D. Improve their occupational, social, and psychological functioning.


8. Although reliance on medication alone is not uncommon, a combination of psychosocial treatment and medication generally is recommended for the treatment of alcohol or opioid use disorders.

A. True

B. False


9. MAT for opioid use disorders using _____ is associated with substantial reductions in the risk for all cause and overdose mortality.

A. Methadone

B. Methadone or buprenorphine

C. Methadone, buprenorphine, or naloxone

D. Methadone, buprenorphine, naloxone, or naltrexone


10. Among individuals who recognized a need for treatment and tried to obtain it, _____ was the most frequently reported reason for not receiving treatment.

A. Not able to leave children home alone

B. Unable to take time off from work

C. Not able to find a physician willing to treat them

D. Lack of health coverage


State Considerations for Covering Medications for Alcohol and Opioid Use Disorders

11. The FDA:

A. Approves drugs for certain indications.

B. Decides how doctors use approved drugs.

C. Decides whether and to what extent Medicare, Medicaid, and private insurers will cover drug costs.

D. The FDA approves drugs for certain indications, decides how doctors use approved drugs, and decides whether and to what extent Medicare, Medicaid, and private insurers will cover drug costs.


12. The FDA evaluates a product’s safety, efficacy, and cost as part of the drug approval process.

A. True

B. False


13. The FDA describes generic drugs as “copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.”

A. True

B. False


14. Which of the following is not yet available in generic form?

A. Acamprosate

B. Disulfiram

C. Extended-release injectable naltrexone

D. Oral naltrexone


15. In general, scientific research has found that medications for alcohol use disorders:

A. Help maintain abstinence.

B. Reduce the risk of relapse.

C. Reduce heavy drinking.

D. Scientific research has found that medications for alcohol use disorders help maintain abstinence, reduce the risk of relapse, and reduce heavy drinking.


16. Acamprosate may be most effective among individuals who are motivated for complete abstinence from alcohol and when provided over a long period of time.

A. True

B. False


17. Disulfiram, administered orally as a tablet:

A. Prevents alcohol craving.

B. Deters subsequent alcohol consumption by causing unpleasant effects.

C. Disulfiram prevents alcohol craving and deters subsequent alcohol consumption by causing unpleasant effects.

D. Disulfiram neither prevents alcohol craving nor deters subsequent alcohol consumption by causing unpleasant effects.


18. Expert consensus recommends using disulfiram only:

A. With reliable and highly motivated individuals.

B. In monitored situations in which another person administers the medication.

C. In circumstances in which it is necessary to deter an anticipated high-risk situation.

D. Expert consensus recommends using disulfiram only with reliable and highly motivated individuals in monitored situations in which another person administers the medication or in circumstances in which it is necessary to deter an anticipated high-risk situation.


19. Naltrexone has the advantage of:

A. Not being addictive.

B. Not reacting aversively with alcohol.

C. Naltrexone is not addictive and does not react aversively with alcohol.

D. Naltrexone cannot be taken with alcohol due to adverse reactions.


20. Consistent bioavailability of the long-acting formulation of naltrexone contributes to an improved adverse effect profile compared with its oral counterpart.

A. True

B. False


21. Naltrexone for alcohol use disorders is effective at reducing all of the following, except:

A. Infectious disease transmission

B. Alcohol-related mortality

C. The number of heavy drinking days

D. Alcohol craving


22. Which of the following plays a significant role in the effectiveness of naltrexone?

A. Age

B. Gender

C. Genetic factors

D. Socioeconomic status


23. Buprenorphine should not be used during pregnancy.

A. True

B. False


24. Buprenorphine combined with naloxone can be used for which phase of treatment?

A. Withdrawal

B. Induction

C. Maintenance

D. Buprenorphine combined with naloxone can be used for withdrawal and induction as well as for the maintenance phase of treatment


25. Naloxone is combined with buprenorphine to reduce the risk of buprenorphine being misused by injection.

A. True

B. False


26. Those with higher buprenorphine-naloxone doses had fewer aberrant drug tests and greater retention in treatment than those required by a payer to reduce their dosage to _____ or lower.

A. 20 mg/day

B. 16 mg/day

C. 12 mg/day

D. 8 mg/day


27. All of the following describe methadone, except for:

A. Even in properly prescribed doses, it may generate the extreme euphoria of other opioids.

B. It is extremely long acting (24 - 30 hours).

C. When taken daily at an effective dose, it relieves withdrawal and reduces cravings.

D. It saturates the available opioid receptors and inhibits the effects of other opioids that may be ingested.


28. Oral naltrexone is a short-acting opioid antagonist that works by tightly binding to opioid receptors for 8 to 12 hours.

A. True

B. False


29. To prevent severe iatrogenic opioid withdrawal, patients must abstain from opioids for a minimum of _____ days before beginning the naltrexone treatment; thus, it is effective when used following medical detoxification from opioids or after a period of abstinence such as during incarceration.

A. 3

B. 7

C. 14

D. 30


30. Naloxone requires a prescription because it is a controlled substance due to its abuse potential.

A. True

B. False


31. Studies of the comparative effectiveness of different treatments for alcohol use disorders have found greater savings from use of MAT than from use of psychosocial treatment alone.

A. True

B. False


32. Which of the following is the most effective at reducing the cost for alcoholism-related inpatient hospitalizations and detoxification among individuals treated with MAT?

A. Extended-release injectable naltrexone

B. Oral naltrexone

C. Disulfiram

D. Acamprosate


33. Annual cost per patient was lower for those taking methadone than for those taking buprenorphine, largely because of longer hospitalization for those receiving buprenorphine.

A. True

B. False


34. Among those treated with medication, methadone had:

A. The highest drug costs.

B. The highest overall costs.

C. Both the highest drug costs and the highest overall costs.

D. The lowest drug and overall costs.


35. Which of the following is classified as a schedule II drug with a high potential for abuse and may lead to severe psychological or physical dependence?

A. Buprenorphine

B. Naltrexone

C. Methadone

D. Naloxone


36. Which of the following can be prescribed by a physician, nurse practitioner, or physician assistant?

A. Buprenorphine

B. Disulfiram

C. Naloxone

D. Naltrexone


37. Which of the following regulations has been identified as possibly impeding the provision of integrated care, including behavioral health?

A. Facility licensing and certification.

B. Billing requirements.

C. Data exchange.

D. Regulations that may impede the provision of integrated care, including behavioral health, include professional licensure and certification, facility licensing and certification, billing requirements, and data exchange.


38. Which of the following is not MAT per se but is used to reverse opioid overdose?

A. Buprenorphine

B. Disulfiram

C. Naloxone

D. Naltrexone


39. New York law defines an “opioid antagonist recipient” as:

A. A person at risk of experiencing an opioid-related overdose.

B. A family member, friend, or other person in a position to assist a person experiencing or at risk of experiencing an opioid-related overdose.

C. An organization registered as an opioid overdose prevention program that allows the dispensing of naloxone.

D. New York law defines an “opioid antagonist recipient” as a person at risk of experiencing an opioid-related overdose, a family member, friend, or other person in a position to assist a person experiencing or at risk of experiencing an opioid-related overdose, or an organization registered as an opioid overdose prevention program that allows the dispensing of naloxone.


Medicaid Coverage of Medications for Alcohol and Opioid Use Disorders

40. Given that methadone is involved in one out of every three accidental overdose deaths, it has been suggested that the process for obtaining methadone to treat pain might benefit from greater control.

A. True

B. False


41. Providers are not permitted to prescribe drugs on a preferred drug list without seeking prior authorization.

A. True

B. False


42. Which of the following occurs when a claims processor must verify that the patient first tried a more cost-effective medication before filling a more expensive alternative?

A. Prior authorization

B. Step therapy

C. Psychosocial treatment

D. Quantity level limits


43. Attributing preferred status to _____ as a form of MAT is not possible, given the different method of dispensing and strict restrictions on access governed by federal law.

A. Buprenorphine

B. Naltrexone

C. Methadone

D. Naloxone


44. Quantity or dosing limits are least common for:

A. Buprenorphine

B. Disulfiram

C. Naloxone

D. Naltrexone


45. Quantity or dosing limits for _____ are used by 45 states.

A. Buprenorphine

B. Disulfiram

C. Naloxone

D. Naltrexone


46. Lifetime treatment limits are most commonly applied to:

A. Buprenorphine

B. Methadone

C. Naloxone

D. Naltrexone


47. New York regards any treatment using _____ for longer than 1 year as “investigational” and not medically necessary.

A. Oral naltrexone

B. Extended-release injectable naltrexone

C. Implantable buprenorphine

D. Buprenorphine-naloxone


48. Step therapy requirements are more common for the _____ drugs.

A. Buprenorphine

B. Methadone

C. Naloxone

D. Naltrexone


49. Studies have found that 1 year after discharge from treatment programs, almost 100 percent of individuals relapse in using alcohol or illicit drugs.

A. True

B. False


50. All 50 states and the District of Columbia cover at least one of the three formulations of:

A. Buprenorphine

B. Methadone

C. Naloxone

D. Naltrexone


Innovative MAT Provision, Coverage, and Financing Models

51. The successful integration of MAT into SUD and co-occurring disorders treatment led Missouri to require all Certified Community Behavioral Health Clinics in the Prospective Payment System demonstration provide all form of MAT other than:

A. Buprenorphine

B. Methadone

C. Naloxone

D. Naltrexone


52. Missouri has found that addressing negative perceptions of SUD treatment, whether held by providers, patients, or patients’ families, is critical to success.

A. True

B. False


53. Missouri has found best prescribing practice to be for prescribers providing particular medications uniformly.

A. True

B. False


54. Which of the following is a factor that may affect access to MAT?

A. Lifetime limits

B. Level of burden associated with prior authorization

C. State licensure requirements

D. Factors that may affect access to MAT include lifetime limits, level of burden associated with prior authorization, and state licensure requirements


55. Although qualifying nurse practitioners and physician assistants will now be allowed under federal law to receive a DATA 2000 waiver and prescribe buprenorphine, some states have explicit restrictions in place on prescribing buprenorphine by non-physicians.

A. True

B. False


Conclusion

56. Research on the use of prior authorization with psychiatric medications has revealed that prior authorization may reduce medication expenditures but also may have the unintended consequences of reducing use of the medication and access to treatment.

A. True

B. False


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