The American Medical Association and Manatt Health urged states on Monday to step up their game to ensure residents have adequate access to opioid use disorder treatments.
In a new report, the two organizations zeroed in on the efforts of four states that have particularly innovative strategies: Colorado, Mississippi, North Carolina and Pennsylvania. The report focused on reducing access barriers in Medicaid and state-regulated commercial health plans.
"There are no single magic wand solutions," AMA President Dr. Patrice Harris said on a call with reporters on Monday. "There are, however, best practices that have been ongoing in many states and are working. But those aren't always widely shared for a variety of reasons."
States need to use their oversight and enforcement authority, develop long-term funding strategies and evaluate what strategies will really work to increase treatment access.
The team's goal was to examine what policies are working currently and what could be realistically expanded into other states, according to Joel Ario, a managing director at Manatt Health and author of the report.
One of the AMA's and Manatt's recommendations was for states to remove barriers to medication-assisted treatment for opioid use disorder. Medicaid agencies in North Carolina and Pennsylvania have eliminated prior authorization for the leading forms of medication-assisted treatment and used federal grants to provide training and support to providers who offer those services.
Multiple state legislatures are now working to remove prior authorization for medication-assisted treatment in commercial insurance plans, and at least 10 states have successfully done so. Some states also ensure medication-assisted treatment options are on policies' lowest cost-sharing tiers. In Pennsylvania, the state's governor in 2018 worked out an agreement with the state's seven largest payers to eliminate prior authorization from most forms of medication-assisted treatment, expanding on what had already been in place in the state's Medicaid program. Blue Cross of North Carolina announced it was removing prior authorization for buprenorphine the same year.
Although the federal law that requires parity across mental health and substance use disorder benefits and physical health service benefits took effect in 2008, the report notes actual mental health parity is still a work in progress. States can play a role, however, by stepping up their active oversight and market conduct examinations, which typically involve reviews of policies, procedures and claims to determine whether insurers are meeting their obligations.
Colorado's Division of Insurance is undertaking so-called market conduct exams, and rejected 11 such exams this year because while the companies had identified disparities in physical and mental health coverage, they failed to determine why they were happening, Kate Harris, the agency's chief deputy commissioner of life & health policy, said on a call with reporters.
"It's not enough just to note that a disparity exists," she said. "You want an exam to be as thorough as possible and turn over as many rocks to protect consumers. We really found it incredibly important to have a satisfactory and thorough in-depth review of the parity exams for those reasons."
Pennsylvania is also in the midst of market conduct exams for mental health parity. So far, all of them have turned up violations and have doled out corrective action to ensure insurers are fixing those problems, Jessica Altman, the state's insurance commissioner, said during a call with reporters.
Network adequacy also can pose a barrier when it comes to timely access to treatment, according to the report. States should determine the current capacity of provider networks to treat enrollees with opioid use disorder, understanding that some state regulations limit the number of patients they can treat with medication-assisted therapy.
"It's one thing to say something is covered," Ario said. "It's another thing whether there are providers are available to provide the covered benefit."
The report also highlighted the importance of expanding access to naloxone and other forms of pain treatment outside of opioids, such as occupational therapy, physical therapy and lidocaine patches.
In terms of funding opioid use disorder treatment, the report noted that grants are helpful, but long-term, sustainable funding sources will be necessary to continue to help patients. It also said that evaluating outcomes to understand what strategies work and which do not are a key part of the response, although states are just starting out in this area.
"We clearly do want to measure what works and what doesn't work," Ario said, "and where it doesn't, replace it."