The AMA, California Medical Association (CMA) and Vermont Medical Society (VMS) are supporting bills that would increase access to medication-assisted treatment (MAT) and remove barriers to care for patients with substance use disorders throughout the state.
California Assembly Bill 2384 would remove administrative barriers—such as prior authorization and step therapy—for MAT as well as ensuring that formularies used by health insurance companies and public payers include all forms of MAT. It also would:
- Remove annual/lifetime dollar limits for treatment of opioid use disorder.
- Remove limitations to a predesignated treatment facility; step therapy or fail first policies.
- Ensure that MAT's financial requirements are no different than those for other illnesses covered by the health plan.
"The CMA is committed to helping patients obtain timely treatment for opioid use disorder, which can immediately save lives," said CMA President Theodore M. Mazer, M.D. "California is leading the country in reducing overdose deaths from prescription opioids, and we must now seize the chance to lead in providing critical Medication Assisted Therapy (MAT), as well as non-medication services to assist recovery. By removing barriers to some of the most effective and innovative treatment of substance use disorders, AB 2384 will continue California's commitment to reverse the opioid epidemic while addressing real needs of patients with chronic or acute pain."
"A.B. 2384 will unquestionably help save many lives," said James L. Madara, MD, AMA Executive Vice President and CEO in a letter to the bill's sponsor, California Assemblyman Joaquin Arambula, MD.
The AMA also is supporting Vermont Senate Bill 166 (scroll to page 51), which would increase access to MAT for those who are incarcerated, including helping identify those with an opioid use disorder, and ensuring that a person currently receiving medication assisted treatment (MAT) remains on MAT; or that a person who has an opioid use disorder can begin treatment with MAT when entering jail or prison.
"The AMA and VMS are particularly pleased to see that Vermont will further enhance its nationally-recognized 'hub and spoke' model for increasing access to treatment for opioid use disorder by working collaboratively with the health care community and opioid treatment programs throughout the state," wrote Dr. Madara and Trey Dobson, M.D., President, Vermont Medical Society.
A slightly amended version of S. 166 passed the Vermont Senate last week and is heading to the House.
A 10-hospital pilot led by Colorado's emergency medicine community to improve pain care and reduce the state's opioid supply available for diversion recently reported a 36 percent decrease in opioid prescribing during the 6-month pilot study. The study relied heavily on guidelines developed by the Colorado chapter of the American College of Emergency Physicians (COACEP).
The COACEP Guidelines are a comprehensive approach to pain management and harm reduction strategies, including multiple sections with practice recommendations, use of non-opioid medications as well as policy recommendations. The guidelines were developed by a multidisciplinary panel of emergency physicians, addiction and harm reduction specialists, pharmacists, paramedics, emergency department nurses, and medical students. According to COACEP, "These guidelines are not meant to replace clinical judgment, but rather inform and augment it. Although we acknowledge the value of opioids in certain clinical situations, including the treatment of cancer pain or hospice patients, we advocate extreme caution in all cases."
For more information about the guidelines, please contact Barb Burgess, Executive Director, Colorado Chapter, American College of Emergency Physicians, at (303) 255-2715.
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