Advocacy Update

Jan. 10, 2019: State Advocacy Update


Below is an excerpt from a Leadership Viewpoints column written by AMA President Barbara L. McAneny, MD:

Every day in America, about 130 people die of opioid-related drug overdoses, the majority of which are due to heroin and illicit fentanyl. That data from the Centers for Disease Control and Prevention (CDC) should spark our nation to move to eliminate every barrier to medically proven, lifesaving treatment for opioid-use disorder (OUD) and other substance-use disorders.

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The Commonwealth of Pennsylvania last fall removed one of the most senseless and short-sighted forms of prior authorization that exists—one that delays access to medication-assisted treatment (MAT) for opioid-use disorder. Nearly 5,000 Pennsylvanians died of drug overdoses between March 2017 and March 2018, the CDC says.

When it comes to treating patients with OUD, we know what works (PDF). MAT for opioid-use disorder saves lives. MAT helps people maintain recovery, saves money, reduces crime, and helps people regain their health and their lives.

These are just some of the reasons why the U.S. surgeon general's Spotlight on Opioids (PDF) report calls MAT the "gold standard" for treatment.

But time is of the essence, and payers across the nation commonly impose prior-authorization requirements that patients and physicians must meet before medications are available for treatment. When patients seek help, it is unconscionable to make them wait days or weeks for the right treatment.

There is no valid reason to delay or deny medically proven care that can help end the nation's opioid epidemic and improve patients' health and lives.

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After seven years in private practice, Rachel Franklin, MD, returned to where she finished her residency in family medicine and saw a need to improve the way the family medicine center treated its pain patients. She started from the ground up. Taking on the role of medical director at the University of Oklahoma College of Medicine's Family Medicine Center, she "wanted to start over with the way we were teaching pain management as well as the clinic workflow so that we could actually provide an objectively assessed, mechanism-based management program for chronic pain."

Dr. Franklin and her colleagues created a peer-reviewed, structured curriculum that focused on improving patient outcomes. She implemented workflows where patients complete a self-assessment at each visit which includes their medical history, in addition to an opiate risk assessment at their initial visit. Their opioid risk is documented—as are any indications of misuse, non-adherence or diversion of their medication—and patients are then monitored regularly through standardized assessment tools. The clinic also established standard refill expectations, which "greatly improved the whole clinic environment," Dr. Franklin said. "Patients no longer walk in unannounced expecting a refill. We have built in structured expectations and we have seen great results for the patients who have stayed with us."

The objective assessment tools and mechanism-based treatment program are designed to try to help physicians avoid initiating opioids in an effort to balance patient safety with effective pain care.

"With the medical students, we talk about the socio-political aspects of pain management, we talk about the experience of pain, and we talk about a mechanism-based approach to pain. We discuss many different questions, such as: What is neurologic pain? What is functional pain? What is musculoskeletal pain? What is affective pain? And then what can we do within those mechanisms? Everything from acupuncture, physical therapy and biofeedback to complementary medications like magnesium and B-vitamins to the non-opiate medications."

Despite the progress they have seen locally, Dr. Franklin says there are still big changes that need to be made so that patients nationwide can get better, more multidisciplinary treatment: "Until you can give me a policy by which physical therapy, occupational therapy, massage therapy, acupuncture, biofeedback and behavioral health are as cheap as a five-dollar prescription for [an opioid] each month, I'm going to have problems."

Dr. Franklin also understands that legislative fixes may not always be as helpful as intended. "I teach medical students about the swinging of the political pendulum and how it influences practice in ways that aren't necessarily evidence-based. What we've tried to do with our curricular and advocacy efforts is to balance that pendulum, so that it doesn't swing so far from side to side."

To learn more about what physicians are doing to fight the opioid epidemic please visit the AMA's End the Opioid Epidemic website.

Thanks to the extensive advocacy from the New York State Psychiatric Association (NYSPA), the Medical Society of the State of New York (MSSNY) and more than two dozen statewide organizations and five national groups including the AMA, the Mental Health and Substance Use Disorder (MH/SUD) Parity Report Act (A.3694-C) was signed into law by Governor Andrew Cuomo on Dec. 21, 2018. The law requires insurers to submit key data to the Department of Financial Services for analysis and evaluation of compliance with the federal and state MH/SUD parity laws culminating in the publication of a public report.

"This is a tremendous victory for patients made possible in part by NYSPA working hand-in-hand with MSSNY, the broader MH/SUD community and national partners including the AMA, to generate an enormous volume of communications in support, including letters, phone calls and tweets," said Richard Gallo, NYSPA government relations advocate.

"This law puts New York on a path to achieving enhanced compliance and greater transparency with the MH/SUD parity laws, for which we and all of our national and statewide partnering organizations wish to thank Governor Cuomo, the sponsors of the bipartisan law, Assembly member Aileen Gunther, Senator Rob Ortt, and the entire New York Legislature for their overwhelming support."

In a letter of support, the AMA (PDF) noted that the bill "will provide important data to better compare requirements for accessing benefits that are applied to mental health and substance use disorder treatment and coverage as compared with those applied to medical/surgical benefits."

MSSNY's Physician Advocacy website generated nearly 1,000 letters alone in support to the governor.

For more information, please contact MSSNY's Moe Auster.