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NC Leads the Way in Expanding Access to Treatment for Syphilis


Press Release


In support of ongoing efforts to combat rising cases of syphilis, including congenital syphilis, the North Carolina Department of Health and Human Services is raising awareness among providers and patients of a recent rate increase to support treatment for Medicaid beneficiaries. As of Feb. 1, 2024, the Medicaid reimbursement rate has been increased to reflect the updated costs of the medication Bicillin L-A, which can be used to treat syphilis and is the only known effective treatment for preventing congenital syphilis.


North Carolina proposed the change to the Centers for Medicaid and Medicare Services to increase payment to providers so they can treat people with syphilis or congenital syphilis in their offices instead of referring patients to other places for treatment. This is the first rate increase for Bicillin L-A since 2015.


Data show that in 2023, only 32% of women with symptomatic syphilis received same-day treatment and 34% of women were not treated until more than seven days after their syphilis diagnosis. This change in reimbursement of Billicin L-A for office-based treatment can improve that treatment gap.  


The change for NC Medicaid beneficiaries follows other actions NCDHHS has taken to curb the sharp increase in syphilis and congenital syphilis cases. These efforts include joining other southeastern states in partnership to align on recommendations for standard syphilis screening in pregnant women and for providers to adhere to the requirements around control measures for diseases like congenital syphilis, establishing a provider resource webpage, and launching a public awareness campaign.


"Congenital syphilis is a completely preventable infection with devastating consequences," said State Health Director and NCDHHS Chief Medical Officer, Dr. Elizabeth Cuervo Tilson. "Cases are the highest they have been in 20 years. It will take a data-driven and collaborative effort to reverse this trend and ensure people are getting the care they need."


Between 2012 and 2023 (preliminary data), there was a nine-fold increase in reported syphilis cases among women with an associated 72-fold increase in congenital syphilis infections. In 2023, preliminary data show nine congenital syphilis related stillbirths and neonatal deaths. In North Carolina, more than half of births are to Medicaid-eligible women, making Medicaid a pivotal player in addressing this issue with patients and providers.


NCDHHS has a health care provider outreach campaign ongoing through June 2024 to increase screening of pregnant women in all settings and increase access to rapid tests for syphilis and HIV. This outreach includes a media campaign to help raise awareness about the importance of syphilis testing for all sexually active individuals. As part of the campaign, NCDHHS has created posters and other educational materials to be displayed in locations frequented by people most affected by syphilis, including maternal clinics, local health departments, syringe services programs or other safety net providers. Any organizations interested in receiving free educational materials should submit a request at this request link by March 1, 2024.


To learn more about syphilis and where to get tested, go to the NCDHHS website.


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