AMA Opioid Task Force releases recommendations to increase treatment access

The American Medical Association (AMA) is asking state and federal authorities to step in to help eliminate the current barriers that prevent so many patients with opioid use disorder from receiving appropriate treatment.

AMA’s Opioid Task Force released recommendations in May focused on prior authorization, step therapy, and other administrative barriers that prevent patients from being able to access appropriate and timely medication-assisted therapy (MAT) for treatment of opioid use disorder. 

“Once a patient gets in to see a physician who can prescribe treatment, the treatment needs to be started as soon as possible,” said AMA in a written response to Pharmacy Today. “Delays in starting treatment due to prior authorization or step therapy requirements mean the patient will continue to experience cravings for opioids. If they satisfy this craving, there may not be another opportunity to start them on treatment, either because they do not come back to the physician or because they experience another overdose.”

While most health care practitioners understand that prior authorization and step therapy are meant to ensure that cost-effective therapies are trialed before more expensive ones, Bradlee Rea, PharmD, outpatient pain management clinical pharmacist at Kaweah Delta Health Care in Visalia, CA, said the common argument against this process is that practitioners are cut out from deciding which pharmacotherapeutic option is preferred.

MAT normally combines FDA-approved medications like buprenorphine and naltrexone with behavioral therapy.

In addition, insurance companies should not force a one-size-fits-all approach to treatment of opioid use disorder, said AMA.

AMA’s recommendations also focus on enforcing insurance coverage for treatment of mental health disorders, removing barriers for a more comprehensive approach to patient care, and reducing the stigma associated with MAT.

Although pharmacists can develop treatment plans, monitor patients, and provide other services for patients participating in MAT, there’s a big missing piece.

“The predominant issue with pharmacists being actively involved with managing MAT patients is the inability to obtain a Drug Addiction Treatment Act [DATA] waiver,” said Rea.

DATA waivers are the first step in allowing health care practitioners to prescribe Schedule II/III medications for MAT to treat opioid use disorder. Even if a pharmacist practices in one of the eight states where they have been granted authority to prescribe controlled substances—normally with a collaborative practice agreement in place—the option to prescribe as part of MAT does not exist.

AMA is urging pharmacy associations to join its call to end the administrative barriers that prevent patients from accessing MAT.

For the full article, please visit www.pharmacytoday.org for the August 2019 issue of Pharmacy Today.