Opioids

Life-saving treatment bill advanced in state hit hard by opioid epidemic

The AMA is working with the Kentucky Medical Association, the American Society of Addiction Medicine and the Kentucky Society of Addiction Medicine to pass state House Bill 121. The measure would prohibit commercial insurers from setting prior authorization or utilization-review requirements for drugs used to treat opioid-use disorder (OUD) and prohibit the commonwealth’s Department of Medicaid Services or any Medicaid managed-care organization from doing the same. 

It would also do something else, according to AMA Executive Vice President and CEO James L. Madara, MD. 

“Without question, this bill will save lives in Kentucky,” Dr. Madara wrote in a letter of support to the bill’s sponsor, state Rep. Kim Moser, who represents a district just south of Cincinnati. 

The Kentucky bill was passed by the Health and Family Services Committee on Feb. 7, the full House on Feb. 11, and now moves to the Senate. The legislation represents one of the first efforts in 2019 for states to take action to make it easier for patients with OUD to access medication-assisted treatment (MAT) without delay. 

Dr. Madara noted that U.S. Surgeon General Jerome M. Adams, MD, has called MAT the “gold standard” for OUD treatment. He added that delaying treatment for OUD can “mean relapse or death.” 

AMA President-elect Patrice A. Harris, MD, agreed. 

“Too many people are dying,” said Dr. Harris, who chairs the AMA Opioid Task Force. “We can no longer keep in place unnecessary barriers to treatment such as prior authorization. Kentucky lawmakers—and the governor—now have a chance to lead in the fight against this terrible epidemic and be a model for other states to follow.” 

Progress in Maryland, Colorado, Pennsylvania 

Although there has been a 23 percent drop in opioid prescriptions since 2013, opioid-overdose deaths continue to climb, fueled by illicit fentanyl. Kentucky had the eighth-highest opioid-overdose death rate at 27.9 per 100,000 people in 2017. A major contributing factor to this statistic is that 89 percent of patients needing addiction treatment do not receive it. 

Delaying patients’ access to buprenorphine, methadone or naltrexone in medication-assisted treatment (MAT) for OUD is “one of the most senseless and short-sighted forms of prior authorization that exists,” wrote AMA President Barbara L. McAneny, MD, in an AMA Leadership Viewpoints column published in January. 

In her column, Dr. McAneny noted how AMA and Pennsylvania Medical Society efforts helped secure an agreement between Gov. Tom Wolf and seven major insurance companies in the commonwealth to remove prior authorization requirements for MAT last fall. Colorado and Maryland also have taken important steps forward. Learn more about Pennsylvania’s leading-edge practices in this December 2018 report.  

The Kentucky legislation closely resembles a measure passed by the Maryland state legislature in 2017, where Maryland addiction medicine specialist Yngvild Olsen, MD, credits the law for saving lives and restoring hope. 

“Instead of spending senseless hours each week filling out forms or waiting on the phone to speak with a health insurance company administrator, I can treat more patients and have a greater impact on ending our state’s opioid epidemic,” Dr. Olsen said. 

The AMA is also working Manatt Health and state medical societies to spotlight states that are setting examples and establishing best practices for solving the opioid crisis.  

The most recent report in this effort described how Colorado passed legislation last May to address the epidemic. A package of opioid-related bills included funding to expand the opioid-treatment workforce, stepping up enforcement of mental health parity laws, and reducing PA requirements for MAT. 

This included: 

  • Eliminating prior authorization for naloxone in Medicaid,  
  • Expanding Medicaid coverage for methadone and a naltrexone extended-release injectable. 
  • Eliminating prior authorization in Medicaid for non-opioid pain relievers, antidepressants and Lidocaine patches.