Dec. 20, 2019: State Advocacy Update

After urging from the AMA and multiple state medical societies, national retailer Walmart announced last week that it would delay its mandate for electronic prescribing of controlled substances (EPCS).

Walmart previously said that it would require EPCS for all controlled substances as of Jan. 1, with no exceptions. The AMA and multiple medical societies opposed the mandate (PDF), urging a delay due to the likelihood for patient harm and how the Walmart policy did not comport with state or federal law.

Last week, a Walmart spokeswoman said in a statement to USA TODAY that "We recognize not all provider networks and prescribers will have the technology and systems in place to accommodate this requirement, so we will continue to take written prescriptions so patients are not unintentionally negatively affected by this process."

"The AMA welcomes Walmart's decision to delay implementation of an electronic prescribing mandate that would have resulted in harm to millions of Americans, including many in rural areas who rely on Walmart as the only pharmacy within a reasonable distance," said AMA President Patrice A. Harris, MD, MA. "The policy was not developed in consultation with the nation's physicians, who support electronic prescribing of controlled substances, but want to see it implemented in a manner that supports—rather than disrupts—patient care."

The AMA will continue to monitor this development and encourages your help in sharing this information with your state medical and pharmacy boards, as appropriate, to ensure all pharmacies and other stakeholders comply with state law governing the prescribing and dispensing of controlled substances.

For questions or to share information regarding this story, please send an email to the AMA Advocacy Resource Center at [email protected].

Over AMA objections, OptumRx said it is moving ahead with a mandate for physicians to use electronic prescribing of controlled substances (EPCS) for home delivery beginning Jan. 1, 2020. In a letter to the AMA, OptumRx said physicians should email OptumRx at [email protected] if they believe that they qualify for one of the following exemptions:

• If the physician's state law allows for an exemption, and the physician has one on file with the state
• The physician is located in a rural or remote location with limited internet access
• The physician is planning to convert to EPCS in 2020, but the conversion will not be live before March 2020
• The physician is close to retirement

OptumRx told the AMA that its EPCS mandate also will not apply for those OptumRx members who reside in Alaska, Puerto Rico, Guam or the U.S. Virgin Islands as well as in long term care facilities or in hospice care. Additional exemptions may be allowed by OptumRx "if it will be a hardship for them to use a retail pharmacy for reasons such as disability, transportation challenges, or distance to a retail pharmacy."

If a physician believes that one or more of these exemptions apply, please email OptumRx at [email protected] to confirm.

To help medical societies advocate for patients with mental health or substance use disorders, the AMA, American Psychiatric Association and American Society of Addiction Medicine created an "Enhanced Attestation," parity tool that would require payers to demonstrate in advance that they are in compliance with the federal Mental Health Parity and Addiction Equity Act (MHPAEA), which was enacted in 2008.

While the MHPAEA was enacted on a simple principle—insurance coverage for mental health and addiction treatment should be no more restrictive than insurance coverage for other medical care—the MHPAEA can be complicated. And many insurance departments have learned that a thorough review is time consuming and frustrating—particularly when payers provide incomplete and or inconsistent information.

The "Enhanced Attestation" tool takes federal requirements and puts them into an easy-to-implement checklist to help streamline oversight and, hopefully, increase MHPAEA compliance. The "Enhanced Attestation" tool guides payers through the necessary analyses to demonstrate compliance with the law, which can then be made available to a state department of insurance upon request for its own regulatory review.

To learn more about enhanced attestation (PDF). The complete "Enhanced Attestation" form (PDF) can be found on the End the Opioid Epidemic website. Additional parity resources include APA Fair Insurance Coverage: It's the Law and the ASAM parity toolkit.

• Dec. 20, 2019: Advocacy spotlight: 2020 federal funding and extender package
• Dec. 20, 2019: National Advocacy Update
• Dec. 20, 2019: Judicial Advocacy Update

With an increased number of people reporting worsening mental health in recent years, it is imperative that people are aware of the 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) telephone program.

People experiencing a suicidal, substance use, and/or mental health crisis, or any other kind of emotional distress can call, chat or text 988, and speak to trained crisis counselors. The national hotline is available 24 hours a day, 7 days a week.

The previous National Suicide Prevention Lifeline phone number (1-800-273-8255) will continue to be operational and route calls to 988 indefinitely.