Oct. 4, 2018: State Advocacy Update

Medical students, residents, academic or physicians in clinical practice, can all benefit from reading the Surgeon General's Spotlight on Opioids (PDF). Here are five reasons to do so.

• Ending the epidemic requires a comprehensive, patient-centered focus. The report provides the evidence base that provides important support for comprehensive care rather than a one-size-fits-all approach
• Medication-assisted treatment works for treating substance-use disorders. All patient populations can be treated with MAT, including mental health patients, pregnant women and criminal justice populations.
• There are multiple harm-reduction strategies to pursue. In addition to naloxone access, strategies to reduce opioid-related harms include needle or syringe exchange which reduce transmission of infectious disease.
• Recovery requires ongoing care and removing stigma. Improving access to care and helping ensure high-quality evidence-based treatment requires medical oversight and effective integration of prevention, treatment and recovery services across the health care continuum. SUDs can and should be treated like any other chronic condition.
• It's a quick read. The report will take less than one hour to read, and it will almost certainly increase your knowledge about the epidemic.

Learn more about what physicians can do to end the opioid epidemic on the AMA's website, and read more about the Surgeon General's report at AMA Wire®.

Seventy percent of neurosurgeons need to use a separate website to access their state PDMP, according to a new study published in the October issue of Neurosurgery. Sponsored by the Council of State Neurosurgical Societies, the study looked at neurosurgeons' use of PDMPs in states with—and without—mandates to use PDMPs. Among the other findings:

• Who checks the PDMP? Fifty-three percent of respondents in states with mandates checked the PDMP themselves compared to 31 percent of respondents in states without mandates.
• Does checking the PDMP add time to workflow? Almost one quarter percent of respondents in states with—and without—mandates said that checking the PDMP adds time to the workflow of their practice, but it is worth it. Almost one third of respondents in mandate states said that it creates workflow disruptions compared to only 13 percent of non-mandate respondents.
• How do patients react? Half of respondents in mandate states said that patients "often" or "sometimes" respond with anger or denial when the neurosurgeon discusses the patient's PDMP data compared to only 39 percent of respondents in nonmandate states.
• Does the PDMP help with prescribing decisions? More than one third of respondents in mandate states "strongly agreed" or "agreed" that the PDMP helped in prescribing pain medications for patients with 31 percent "neutral," compared to 28 percent of respondents in non-mandate states "strongly agreed" or "agreed" that the PDMP helped in prescribing pain medications for patients with 40 percent neutral.

The authors noted that "while the PDMP plays an important role in identifying patients with potentially problematic opioid use, the impositions on day-to-day neurosurgical clinical workflow and barriers to accessibility can limit the widespread use and efficacy of the PDMP."

The Medical Society of Virginia (MSV) and Gov. Ralph Northam, MD, are partnering to host a Health Care Provider Opioid Summit on Oct. 20 in Roanoke, Va. It will include officials from Virginia, South Carolina, Maryland and the Appalachian Regional Commission as well AMA President-elect Patrice A. Harris, MD, MA. The summit will focus on how states, stakeholders, health care providers and physicians can partner together "the next phase of overcoming the crisis."

The summit also will include options for physicians to take buprenorphine-waiver training and a two-hour training focused on pain management for continuing medical education (CME) credit.

More information can be found here.

The AMA Opioid Task Force strongly supports removing barriers that stand between patients and MAT for opioid-use disorder (OUD). Prior authorization for MAT has potentially dangerous consequences for patients who are forced to delay care or are denied treatment because of administrative barriers.

Yngvild Olsen, MD, MPH, who is a member of the Maryland State Medical Society (MedChi) Opioid Task Force and co-chair of the MedChi Addiction Committee, recently spoke with the AMA about the devastating effects these prior authorization policies can have.
"Patients would go to the pharmacy only to be told that their [buprenorphine] prescription couldn't be filled," Dr. Olsen said. "I would get frantic calls from patients after they'd been denied their medication. I had one woman say, 'What am I supposed to do today?' She was on her last dose of medicine." Ninety-nine percent of the time prior authorization requests are approved, so the delay is a senseless bureaucratic hurdle that can be the difference between continued recovery and relapse for vulnerable patient populations.

Medicaid took the initiative to drop prior authorization for MAT, she said, but this still left barriers in place for commercially insured patients. To address the problem the Maryland-DC Society of Addiction Medicine partnered with MedChi and proposed a bill to have prior authorization requirements for MAT lifted for commercial insurers.

"There was no opposition to this bill," said Dr. Olsen. "The commercial payer lobbyist was so excited that they were doing this, he went in and hugged the lobbyist from the state medical society. Medicaid was the driver of change in the commercial market, and they did that by setting the precedent."

Gene M. Ransom, the chief executive officer of MedChi, agreed.

"We think that everyone got on board because of the focus on supporting high-quality, evidence-based medical treatment," Ransom said. "Working with policymakers and others, we all agreed that it was time to put aside any differences we might have and support patients getting the care they need. This is a common-sense solution that doesn't cost any money, and it should be this easy to do this everywhere."

House Bill 887 prohibits carriers that provide coverage for prescription drugs from applying a preauthorization requirement for medication used for treatment of an OUD. It was signed into law on May 25, 2017. Dr. Olsen has seen the difference this change has made in her practice almost immediately. No longer does she have to spend hours a week answering panicked phone calls from patients at the pharmacy, and then making calls to the insurer and pharmacists to try and straighten it out. But the biggest change was removing the fear of "will I be able to fill my prescription?" for her patients.

To see what other progress is being made in battling the opioid epidemic across the country, read the latest AMA Opioid Task Force progress report (PDF).

For support in eliminating prior authorization burdens for MAT at the state level, contact [email protected], senior legislative attorney, AMA Advocacy Resource Center.

The AMA recently announced the release of the latest series of Geographic Mapping Initiative maps, or "Geomaps." Geomaps illustrate the practice location of physicians and non-physicians in all 50 states and the District of Columbia. New to this version are maps illustrating the location of dermatologists, and of physician assistants. The maps are a powerful tool in legislative or regulatory advocacy related to scope of practice and the health care workforce.

For access to AMA Geomaps for your state or specialty, please contact Kristin Schleiter, senior legislative attorney, at the AMA Advocacy Resource Center.

• Oct. 4, 2018: Advocacy spotlight on Congress passes new opioid package 
• Oct. 4, 2018: National Advocacy Update