National Opioid Policy Roadmap highlights state efforts to end the epidemic

Sept. 10, 2019

The American Medical Association (AMA) and Manatt Health released an analysis identifying effective state policies used to combat the opioid epidemic.

The analysis looked at the response to the epidemic in four states and determined which polices increased access to evidence-based treatment for people with a substance use disorder. The AMA and Manatt originally reviewed policies in Colorado, Mississippi, North Carolina and Pennsylvania and used those analyses along with additional work to develop recommendations for state health care policy.

“We are at a crossroads in our nation’s efforts to end the opioid epidemic, and states are being creative on how they respond,” said AMA President Patrice A. Harris, MD, who also is chair of the AMA Opioid Task Force. “It is time to end delays and barriers to treatment; time for payers, PBMs and pharmacy chains to revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to help all patients access evidence-based care for pain and substance use disorders. Physicians must continue to demonstrate leadership, but unless and until these actions occur, the progress we are making will not stop patients from dying.”

The national roadmap highlights six key areas where regulators, policymakers, and other stakeholders can take action:

• Improving access to evidence-based treatment for opioid use disorder. Remove prior authorization and other barriers to medication-assisted treatment (MAT) for opioid use disorder—and ensure MAT is affordable.

• Enforcing parity laws. Increase oversight and enforcement of mental health and substance use disorder parity laws.

• Addressing network adequacy and enhancing workforce. Ensure adequate networks that allow for timely access to addiction medicine physicians and other health care professionals; this includes payment reforms, collaborative care models, and other efforts to bolster and support the nation’s opioid use disorder treatment workforce.

 • Expanding pain management options. Enhance access to comprehensive pain care, including non-opioid and non-pharmacologic options.

 • Improving access to naloxone. Reduce harm by expanding access to the overdose-reversing drug and coordinating care for patients in crisis.

• Evaluating policy success and barriers. Evaluate policies and outcomes to identify what is working, building on successful efforts and identifying policies and programs that might need to be revised or rescinded.

“These recommendations are already proving effective in leading states,” said Joel Ario, managing partner, Manatt Health Strategies, and former insurance commissioner in Oregon and Pennsylvania. “If state policymakers want to have a tangible impact on improving patient care, these are the policies that are showing real promise. This is not hypothetical—this is what is needed to end the epidemic.”

 The recommendations by the AMA and Manatt emerged from four key themes in the earlier analyses of Colorado, Mississippi, North Carolina, and Pennsylvania:

• Vigorous state oversight and enforcement. State regulators can have a significant impact on reducing barriers and improving patient care, and some have used these tools to increase access to evidence-based treatment. Regulators have successfully held payers and others accountable for restricting access by using prior authorization to for medication assisted treatment (MAT). Additionally, states have found success by enforcing state and federal insurance parity laws, benefitting patients needing treatment for mental health or substance use disorder.

 • Medicaid expansion. Medicaid often provides more comprehensive care for substance use disorders than commercial insurance market, often by removing barriers to MAT and providing greater access to non-opioid pain care.  Expanding Medicaid in states that have not yet done so would establish a strong foundation to help even more patients.

 • Long-term funding. Grants are being used to advance many best practices, but to continue saving lives, states need long-term, sustainable funding. Without reliable funding streams, programs that are showing promise to reduce overdose and death -- and to connect patients to treatment – might simply disappear.

 • Measuring success. Some states are evaluating policies and programs to determine what works. Most of these evaluations are just beginning. Comprehensive analysis is essential to focus resources on successful interventions—and to revise or rescind policies that are having unintended consequences.