Location: RM 271
Insurance Coverage for Opioid Medications and Addiction Treatment
OPIOID AND OTHER SUBSTANCE USE DISORDERS
|Votes: View-->||Action Taken:|
01:25 PM -- Insurance Coverage for Opioid Medications and Addiction Treatment
Representative Pettersen reconvened the committee.
Dr. Elizabeth Kraft, Anthem, provided a handout to the committee (Attachment F) and discussed Anthem's efforts in providing access to substance use disorder prevention, early identification of drug misuse problems, and treatment. She discussed Anthem's efforts to: align pharmacy benefits with the Center for Disease Control (CDC) guidelines for prescribing opioids for chronic pain; create the Pharmacy Home program; promote use of naloxone and remove prior authorization for its use; and a Medicare opioid utilization management program. She explained that the Pharmacy Home program addresses health and safety concerns of patients by reviewing pharmacy data to identify patient who are prescribed opioids and potentially dangerous drug combinations by multiple prescribers. If a covered individual is identified, a letter is sent to the patient and the providers expressing Anthem's concern for the patients health and safety.
In response to committee questions, Dr. Kraft explained that health plans do not have access to PDMP, but Anthem does encourage its providers to review the PDMP when prescribing opioids. Dr. Kraft told the committee that Anthem does not require prior authorization for the use of noloxone or MAT medications. Discussion about network adequacy followed.
Dr. Kraft discussed alternative treatments for pain, such as massage and PT. She discussed access to mental health services via telehealth and efforts to track and address substance use disorders. Committee questions and discussion ensued about in-patient substance use disorder treatment, access to physical therapy, and parity laws for substance use disorders.
Tom Denberg, Pinnacol Assurance, provided a handout to the committee (Attachment G). He explained the workers' compensation system and clarified that employers pay the entire cost, and benefits are determined by state statute. He listed the types of treatments that are covered, including alternatives to opioids. He explained the correlation between opioid use and the level of disability of the worker. He told the committee that opioid prescriptions account for 17 percent of the prescriptions written for workers receiving workers' compensation benefits. Referring to pages 4 and 5 of the handout, Mr. Denberg discussed strategies employed by the Division of Workers' Compensation and Pinnacol to treat opioid misuse. Committee questions and discussion followed.
Mr. Denberg outlined Pinnacol's recommendations to address opioid use among workers receiving care under the workers' compensation program listed on page 7 of his handout, and responded to questions from the committee about the laws and rules affecting the care provided under workers' compensation.
Amy Newton, Pinnacol Assurance, responded to questions from the committee about the way Pinnacol provides information about prescriptions written for patients and alternative treatments.