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Enhancing Access to Stabilizing Medications for Addiction Treatment

ASAM's Advancing Access to Stabilizing Medications initiative focuses on improving access to addiction treatment medications. Research findings, state Medicaid survey results, and commercial insurer coverage are explored and detailed on ASAM's website.

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Enhancing Access to Stabilizing Medications for Addiction Treatment

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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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