Transcript ASAM’s Advancing Access to STABILIZING Medications

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Professional society founded in 1954 representing
3,100+ physicians & other associated professionals
Mission:
 Increase access to & improve the quality of addiction
treatment
 Educate physicians, other health care providers & public
 Support research & prevention
 Promote appropriate role of the physician in patient care
 Establish addiction medicine as a recognized specialty
April 2012:
May 2011:
Dr. Mark Publicker,
an ASAM addiction
specialist physician,
alerted ASAM to
Maine legislation
that limits patient
access to addiction
medications.
ASAM Board of
Directors appointed a
Patient Advocacy
Task Force (PATF) to
advocate for patient
access to evidencebased, cost-effective
medication
treatment for opioid
dependence.
June 20, 2013:
PATF Stakeholder
Summit at The
National Press Club
in Washington, DC;
Report results are
disseminated.
October 23, 2013:
September 30, 2013:
ASAM Hill Briefing
on pharmacotherapy
for opioid addiction
treatment.
ASAM Legislative
Day on Capitol Hill;
ASAM members
bring awareness of
the issue to
policymakers.
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State Medicaid survey of coverage & access
Commercial insurer survey of coverage & access
Literature reviews of clinical and costeffectiveness of stabilizing medications
to treat opioid addiction
TRI and Avisa Group research results available
on ASAM’s website (www.asam.org)
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Every state Medicaid program covers at least one of
the FDA-approved medications
Many state Medicaid programs have implemented
authorization requirements which must be met prior
to payment for these medications
Requirements for approval range from limited to
severe, and may include “fail first” policies or a
history of frequent service utilization
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Inclusion in a plan’s formulary does not equate to
easy access
Utilization Management (UM) can reduce access
Most common UM requirements are:
 Prior authorization
 Quantity and dosage limits
 Step therapy or “fail first” requirements
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Most widely available is Suboxone & new
formulations may make it even more available
 Generic formulation approved by the FDA in March,
2013, is available in about 50% of plans studied
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While methadone is available in Opioid
Treatment Programs (OTPs), ASAM’s study found
no commercial coverage
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All medications are FDA approved (methadone*)
 Hundreds of effectiveness studies
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All medications have demonstrated modest or better
cost effectiveness in maintenance
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No evidence for effectiveness in detoxification
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All medications are under-utilized
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All reports and resources are available online at
http://www.asam.org/docs/advocacy/Implication
s-for-Opioid-Addiction-Treatment