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ASAM’s Advancing Access to STABILIZING Medications

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:

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ASAM’s Advancing Access to STABILIZING Medications

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  1. ASAM’s Advancing Access to STABILIZING Medications

  2. 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

  3. Advancing Access to Stabilizing Medications

  4. 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)

  5. 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

  6. Coverage of FDA-Approved Stabilizing Medications

  7. Lifetime Limits on Buprenorphine Prescriptions

  8. 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

  9. 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

  10. 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

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

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