Dec. 13, 2018: State Advocacy Update

The AMA, Pennsylvania Medical Society (PAMED) and Manatt Health today released the first study of a state's response to the opioid epidemic. Focusing on Pennsylvania, the spotlight analysis found that considerable progress is being made to increase access to evidence-based treatment for substance use disorders. This includes the landmark agreement last month between the Governor's administration and the seven largest insurers in the state, fully removing prior authorization requirements for medication-assisted treatment (MAT) to treat substance use disorder.

"We conducted this analysis because it's essential that policymakers know what is working, and where additional progress can be made," said Patrice Harris, MD, AMA president-elect and chair of the AMA Opioid Task Force, in a video. "There is long way to go to fully end the epidemic in Pennsylvania and across the nation, but it's clear that Pennsylvania's policymakers are employing multiple strategies that are showing promise."

The spotlight analysis reviewed how well Pennsylvania is making progress in three main areas:

• Increasing access to high-quality, evidence-based care for substance use disorders
• Providing comprehensive care to patients with pain
• Enhancing access to naloxone

Based on available data, review of key policies, and discussions with key policymakers, the spotlight analysis found that there were four key areas where the Commonwealth was succeeding:

• Comprehensive support for MAT
• Enforcement of mental health and substance use disorder parity laws through detailed market conduct examinations of health insurance companies
• Comprehensive naloxone access policies
• Medically-based oversight for Medicaid patients with careful review of care plans for patients with an opioid use disorder as well as for patients with chronic pain

Pennsylvania has been hit hard by the opioid epidemic with prescription opioid-related overdose growing in the early 2000s and more recently, high volumes of heroin and fentanyl coursing through the Commonwealth. The challenges faced by the Commonwealth make for an ideal case study for other states of how strong leadership can make a difference—even if the fight is not over yet.

The spotlight analysis also found areas where additional progress could be made, including continued enforcement and refinement of tools to identify parity violations, expanding efforts in emergency departments and law enforcement to link efforts to coordinate patients' access to high quality, evidence-based treatment, and more.

Visit the AMA's End the Epidemic website to access the full report.

Dec. 18 is the last day to register and book your hotel room for the AMA State Advocacy Summit, Jan. 10-12, in Scottsdale, Arizona. Ashish K. Jha, MD, MPH, director of the Harvard Global Health Institute, who earlier this year authored a widely read and cited study of health care costs published in JAMA, is the keynote speaker.

Key topics to be debated and discussed at the meeting include:

• Pharmacy benefit managers: What do they do?
• Managing Medicaid priorities in 2019
• A thousand cuts and a thousand opportunities: How states can restore and improve access to care in the individual market

The AMA and Oregon Medical Association (OMA) joined together to voice concerns over a new Oregon proposal that could interfere with the ability of pain patients to receive individualized care. The proposal aims to have all patients receiving opioid therapy tapered to zero opioid exposure.

The AMA and OMA wrote in a joint statement, "We request that recommendations be written with an acknowledgment of the fact that there may be patients who never reach zero use due to medical complexities and diagnosis, among other factors. And we further request inclusion of language stating that neither patients nor physicians should ever be forced into nonconsensual tapering protocols by payers or the state that contravene the treatment plan prescribed by the provider."

The medical societies' concerns were echoed by many national pain experts. "There is no demarcation or line in the sand where this dose of opioids is unsafe and this dose of opioids is safe," said Dr. Sean Mackey, a pain medicine specialist at Stanford University to the Bend Bulletin.

Dr. Mackey and other national pain experts detailed their concerns in a letter to the Oregon Health Authority. The Oregon proposal must pass at least two additional Oregon committees before it would go into effect.

For more information, please contact the OMA's Aaron Ragan-Fore.

The American Academy of Pediatrics (AAP) is offering complimentary access (PDF) (for a limited time) to a new course for pediatricians and other interested physicians to help with adolescent substance use screening, brief intervention and referral to treatment (SBIRT). The course will help physicians identify and close gaps in their practice related to SBIRT using practical tools, while earning continuing medical education credit and meeting part 4 (performance in practice) maintenance of certification credits. To access more AAP resources, visit the AMA opioid microsite.

The Providers Clinical Support System (PCSS) has developed a new eight-hour MAT waiver course that is entirely online. After taking the course, physicians and other health care professionals eligible for an MAT waiver should be able to:

• Review addiction identification and evidence-based treatments
• Discuss the pharmacology of opioids as it relates to treatment of opioid use disorder (OUD) patients
• Describe the fundamentals of office-based opioid treatment including the treatment of the co-morbid patient
• Explain the process of buprenorphine induction as well as stabilization and maintenance
• Discuss other approved antagonist and agonist medications to treat OUD
• Discuss basic office protocols including medical record documentation and confidentially
• Utilize evidence-based resources to ensure providers have the confidence to prescribe buprenorphine for patients with OUD
• Apply for a MAT Waiver Training Certificate to begin treating patients with OUD

See more PCSS resources at the AMA opioid microsite.

• Dec. 13, 2018: Advocacy spotlight on First national estimate of telemedicine use by physicians
• Dec. 13, 2018: National Advocacy Update
• Dec. 13, 2018: Judicial Advocacy Update