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Support research & prevention Promote appropriate role of the - - PowerPoint PPT Presentation
Support research & prevention Promote appropriate role of the - - PowerPoint PPT Presentation
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
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May 2011:
- Dr. Mark Publicker,
an ASAM addiction specialist physician, alerted ASAM to Maine legislation that limits patient access to addiction medications. April 2012: ASAM Board of Directors appointed a Patient Advocacy Task Force (PATF) to advocate for patient access to evidence- based, 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. September 30, 2013: ASAM Hill Briefing
- n pharmacotherapy
for opioid addiction treatment. October 23, 2013: 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 cost
effectiveness of medications to treat opioid addiction
TRI and Avisa Group retained to do research Available on ASAM 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 a
variety of authorization requirements which must be met in order for payment for these medications to be approved
Requirements for approval can 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 already available in about 50% of plans studied
While methadone is available in Opioid
Treatment Programs (OTPs) study found no commercial coverage
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All medications are FDA approved (methadone*)
Hundreds of effectiveness studies
All medications have demonstrated modest or better
cost effectiveness in maintenance
No evidence for effectiveness in detoxification All medications are under-utilized –many reasons
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Create briefs and toolkit from research for use by
all for local outreach – especially as state legislatures meet in early 2014
Build and train speakers bureau Plan for 2014 national outreach day Develop national practice guideline
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