AMCP fights back: Abuse-deterrent opioid coverage mandate

September 2, 2015

The Academy of Managed Care Pharmacy (AMCP) is opposing Ohio House Bill 248, because it believes the bill would mandate coverage of abuse-deterrent opioid analgesic drug products “without regard to the balance between the unique and varied needs of individual patients.”

The Academy of Managed Care Pharmacy (AMCP) is opposing Ohio House Bill 248, because it believes the bill would mandate coverage of abuse-deterrent opioid analgesic drug products “without regard to the balance between the unique and varied needs of individual patients.”

AMCP believes that the bill would mandate coverage of abuse-deterrent opioid drugs and limit a health plan and pharmacy benefit manager’s ability to use managed care tools-such as prior authorization and cost sharing. There's little data that such steps would reduce abuse and misuse, according to the AMCP.

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The professional association shared its views in an August 27 letter to Ohio Rep. Anne Gonzales, chair of the Committee on Health and Aging.

Rosato“These products are not appropriate for all patients,” says AMCP chief executive officer Edith A. Rosato, RPh, IOM. “The therapies can be up to 10 times more costly and there is not enough data yet on the how effective they are in addressing abuse. However, we do currently support their use on a patient-by-patient basis.”

Health plans are supporting patient restriction programs for at-risk beneficiaries in Medicare Part D, but right now plans cannot use them on that population, according to Rosato.

“This is not just the responsibility of health plans to fight abuse,” Rosato tells Managed Healthcare Executive. “Prescribers need to be better educated on appropriate prescribing, and those that have been educated need to follow their own guidelines when prescribing these powerful medications to patients,” she says.

Rosato explains that health plans are already working with patients that are at risk, they educate providers and patients about the issues, and they sometimes use prior authorization.

“The showdown between the AMCP and the legislature over Ohio House Bill 248 is caused by what we call in creativity circles a ‘contradiction,’” according to Drew Boyd, author, innovation expert, and a 17-year Johnson & Johnson veteran. “In this case, the contradiction is: as cost of drugs increases, abuse of opioids decreases. From my experience, most contradictions are false because they’re based on incorrect underlying assumptions. For example, AMCP points out what might be a potential false assumption when they say not every patient needs abuse deterrent formulations.

Boyd“The good news is that contradictions are a pathway to highly creative solutions where both sides get 100% of what they want,” Boyd says. “What’s needed are systematic techniques to break down these assumptions and reformulate the contradiction.”