ASAM’S ADVANCING ACCESS TO STABILIZING MEDICATIONS

American Society of Addiction

Medicine (ASAM)

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

Advancing Access to Stabilizing Medications

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 on

pharmacotherapy for opioid addiction

treatment.

October 23, 2013: ASAM

Legislative Day on Capitol Hill; ASAM members

bring awareness of the issue to

policymakers.

ASAM-Sponsored Research

State Medicaid survey of coverage & access

Commercial insurer survey of coverage & access

Literature reviews of clinical and cost- effectiveness of stabilizing medications to treat opioid addiction

TRI and Avisa Group research results available on ASAM’s website (www.asam.org)

ASAM State Medicaid Survey Results 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

Coverage of FDA-Approved Stabilizing Medications

Lifetime Limits on Buprenorphine Prescriptions

Commercial Insurer Findings

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

Commercial Findings (cont’d)

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

While methadone is available in Opioid Treatment Programs (OTPs), ASAM’s study found no commercial coverage

TRI Review of Effectiveness: Conclusions 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

Research & Resources

All reports and resources are available online at http://www.asam.org/docs/advocacy/Implications-for-Opioid-Addiction-Treatment