AMA draws line in the sand on Medicaid caps, drug price transparency

The American Medical Association last week left no room for doubt about its stance on legislative proposals to cap Medicaid funding: It would be "disastrous," AMA board member Dr. Carl Sirio said during the group's annual meeting last week in Chicago.

During debate on a report about congressional efforts to repeal and replace the Affordable Care Act, there was some ambiguity over the association's stance on caps. The AMA House of Delegates ultimately decided to approve language that explicitly opposes Medicaid caps.

Health reform was just one of several controversial issues debated during the annual gathering of the nation's largest doctors' group. The House of Delegates tackled such topics as transparency in drug pricing and transgender bathroom bills during this year's meeting.

During his inaugural address, new AMA President Dr. David Barbe challenged members to be active leaders both within their organizations and nationally. The House of Delegates approved a measure that encourages physicians to increase their involvement on boards of health-related organizations.

"We must oppose efforts to weaken the healthcare system or cause our patients harm. And we must always be open to alternative approaches to achieve our goals," he said. "As physician leaders, we bear greater responsibility within our profession and society. We must continue to put our patients before politics."

Here's a short roundup​ of actions taken by the House of Delegates:

Opioids:​ The AMA delayed voting on a measure that would have allowed physicians to prescribe the drug buprenorphine for the treatment of opioid abuse without obtaining a waiver. Doctors must now complete eight hours of training and other requirements before receiving the waiver that allows them to prescribe the drug.

House of Delegates members who supported removing the training waiver requirement alleged it's a barrier preventing physicians from treating patients suffering from opioid abuse. Those opposing the measure were concerned buprenorphine wouldn't be administered properly without waivers, and that patients would be able to go to an emergency room for a buprenorphrine refill without receiving other ongoing therapies to treat their addiction. The AMA's House of Delegates will likely hold a vote on the measure again during its interim meeting in the winter or at next year's annual meeting.

More broadly, the AMA will create a task force to address a number of issues, including a review of how physicians have responded to the opioid crisis, making recommendations for improving pain management education in medical schools and looking at strategies to better prevent acute pain.

Drug prices:​ The House of Delegates approved several items aimed at bringing more transparency to drug pricing.

Among other things, the group approved policies supporting laws that would:

• Allow the CMS to negotiate drug prices
• Require drug companies to list the suggested retail price of medications in any direct-to-consumer advertising
• Require drugmakers make public any price increases of 10% or more in a given year
• Accelerate review of generic drug applications"

Pharmaceutical prices are completely out of control and that is a public health menace," said a delegate from New England. "This is a public health emergency—let's make sure pharma gets a black eye."

One measure that was not widely supported called for an "out of pocket" maximum of $500 a month per patient. Some members argued that calling for such limits simply shifts costs.

The AMA's resolutions on drug prices came as President Donald Trump, some in Congress and patient advocacy groups campaign for policies to rein in drug prices.

Soda wars:​ The doctors' group amped up its efforts to curb consumption of sugary drinks. Measures approved by the House of Delegates urge physicians to talk with patients about the health risks of soda and other drinks, encourage hospitals to serve healthy beverages, and push to remove sugary drinks from schools.