Parity Enforcement, Barriers to Care, Patients in Pain Highlighted in New AMA Recommendations

With more than 40 states reporting an increase in overdose deaths during the COVID-19 pandemic, the American Medical Association, in partnership with the firm Manatt Health, has published an update to its National Roadmap on State-Level Efforts to End the Nation’s Drug Overdose Epidemic.

The latest version examines progress made on the policy recommendations set forth in the original roadmap, published in September 2019, and provides new action items and showcases best practices in various states.

Returns on 2019 recommendations

Recommendations in the initial report were divided into six categories. In the ensuing 15 months, progress on these fronts has been mixed, AMA reports. A review of the six recommendations and their progress:

• Provide a full continuum of evidence-based care, including medications to treat opioid use disorder, equitably across the healthcare system. An increasing number of states now have laws prohibiting insurers from using prior authorization for MOUD, but more than half still allow the practice.
• Increase oversight and enforcement of parity laws. While some states have enacted more legislation and 30 states have now joined the National Association of Insurance Commissioners (NAIC), a group that refines regulatory tools to hold insurers accountable, regular parity violations are still showing up in compliance exams.
• Ensure adequate networks allow for timely access to treatment and providers trained to treat addiction; support payment reforms, collaborative care and other efforts to support the treatment workforce. Innovative payment models are being explored and some states are attempting to expand access to care, but “much more work remains” on this front, AMA said.
• Enhance access to multimodal pain care, including non-opioid alternatives, remove arbitrary restrictions on opioid therapy for pain patients. States and health insurers “have done relatively little” to increase access to opioid alternatives that have proven effective in treating pain, AMA said.
• Reduce harm by expanding access to naloxone, supporting syringe exchange programs and coordinating care for patients in crisis. AMA lauded states that likely saved “tens of thousands of lives” by improving access to naloxone and embracing needle exchanges, and emergency departments for helping to coordinate care for overdose patients.
• Support standardized data collection. States are gathering more data, but are falling short of using it to implement more effective prevention, treatment and targeted intervention measures. Data across the U.S. continues to not be well standardized, and collection of information that addresses racial, ethnic and gender-related inequities remains inadequate as well.

New recommendations

In its revised roadmap, AMA shared a series of observations that have guided its new recommendations:

• The opioid epidemic continues to expand into a broader drug overdose epidemic.
• Inequities in access to SUD treatment for Black and Hispanic Americans, along with other racial and ethnic groups, persist, and new policies should directly confront these imbalances.
• During the pandemic, increases in financial instability, stress, anxiety, social isolation, and disruption in access to treatment and harm reduction have all contributed to increases in overdose death rates.

With those factors in mind, AMA offered the following updated recommendations:

Increase access to evidence-based treatment for SUD by: eliminating all barriers to MOUD in Medicaid, reducing MOUD barriers in commercial insurance, promoting access to a full care continuum, addressing inequities in treatment options, eliminating barriers for pregnant, parenting and post-partum women, as well as justice-involved individuals, ensure continued access to MOUD and maintaining COVID-19-fueled changes to care delivery options.

Enforce mental health and SUD parity laws by: making such laws more comprehensive, using a full continuum of regulatory tools and sharing resources through the NAIC group

Ensure access to addiction medicine, psychiatry and other trained physicians by: measuring and monitoring provider network capacity, building infrastructure, enforcing parity standards to enhance access to in-network care, offering support to SUD providers struggling as a result of the pandemic and leveraging telehealth.

Improve access to multidisciplinary, multimodal care for both chronic and acute pain patients by operationalizing a multimodal approach to providing coverage through formularies and medical benefits and revisiting policies that arbitrarily restrict opioid prescriptions.

Expand harm reduction efforts by continuing to expand access to naloxone and pursuing more comprehensive harm reduction strategies.

Improve monitoring and evaluation by focusing on data standardization, increasing data surveillance and reporting, and monitoring and evaluating policies.