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PA State Policies Push for Patient Care Access, Opioid Treatment

The AMA report outline how Pennsylvania improved patient care access for those with or at risk for opioid addiction.

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Source: Thinkstock

By Sara Heath

- Healthcare providers and policymakers in Pennsylvania have successfully improved patient care access for opioid addiction treatments, according to a new report from the American Medical Association (AMA), Pennsylvania Medical Society (PAMED), and Manatt Health Today.

Additionally, the state’s healthcare policies have improved health equity, the report stated.

This report, and the numerous other ones like it that AMA plans to publish, aims to outline best practices for supporting better patient access to opioid addiction and substance use disorder (SUD) care.

“We conducted this analysis because it’s essential that policymakers know what is working, and where additional progress can be made,” Patrice A. Harris, MD, MA, AMA president-elect and chair of the AMA Opioid Task Force, said in a statement. “There is long way to go to fully end the epidemic in Pennsylvania and across the nation, but it’s clear that Pennsylvania’s policymakers are employing multiple strategies that are showing promise.”

Specifically, the report outlined the state’s recent agreement with the seven largest Pennsylvania insurers to eliminate prior authorization protocol for medication assisted therapy (MAT).

Insurers typically use prior authorization as a cost containment strategy. Prior authorization rules ask a board of physicians and other healthcare stakeholders to approve a certain treatment for a patient based on health need. However, prior authorization is known to delay necessary treatment, the report suggested.

In removing those barriers, Pennsylvania and its most prominent payers have made it easier for patients in need of addiction treatment to receive those therapies.

Pennsylvania also established 45 Centers of Excellence that expand access to MAT and mental and behavioral health services, AMA reported.

In addition to improving patient access to MAT, Pennsylvania has also expanded access to naloxone, an often life-saving medication that can mitigate the symptoms of a drug overdose.

Furthermore, the state has succeeded in enforcing health equity and health parity laws, thus creating more equal access to treatment. To that end, Pennsylvania state officials investigate markets and health insurers to ensure these entities are adhering to health parity protocol.

Finally, the state has effectively improved Medicaid care plans for both patients with opioid use histories and patients with chronic pain who may genuinely need access to an opioid.

This is a significant step forward as healthcare professionals have worked to strike a balance between responsible opioid prescribing and quelling the opioid crisis.

The state has worked toward that goal by creating a broader network of non-opioid based pain management options. More insurers cover these non-opioid treatments and have also integrated coverage for certain care options such as physical or occupational therapy.

“We are pleased to see this study highlight the important progress Pennsylvania is making in our ongoing battle against the opioid crisis,” Governor Tom Wolf said. “By expanding access to naloxone and medication-assisted treatment, among the many initiatives of our Opioid Command Center, we are rescuing more people and getting them into treatment and recovery.”

The report also outlined areas for improvement.

For example, collaboration between police departments and emergency departments could better coordinate care for patients.

Additionally, state policy could require insurers further clarify non-opioid pain management options by requiring payers to publicize formularies.

Finally, the state can work to promote more prescribing of naloxone to patients who are high risk for an opioid overdose.

The accomplishments listed in the AMA report are only the first steps in Pennsylvania’s efforts to combat the opioid crisis, said PAMED President Danae Powers, MD. The state’s medical association, in partnership with the Governor’s office, plan to continue its improvement efforts.

“We have worked closely with the Wolf Administration and many other stakeholders for the past several years to ensure that policies have a public health and patient focus,” Powers stated. “We look forward to continuing that close engagement to help make more progress.”

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