The Management of Opioids
Where We Stand:
Opioid analgesics have proven to be very effective in controlling acute and chronic pain resulting from various medical conditions. These drugs are highly addictive and are often abused, accounting for a significant number of overdoses and deaths each year. Medical professionals play a key role in facilitating the proper medical use of opioids The Academy of Managed Care Pharmacy (AMCP) supports opioid management initiatives that ensure appropriate patient access and treatment of uncontrolled pain, while limiting abuse and diversion of opioids and opioid potentiators. The improper use of opioids carries enormous direct and indirect costs to our society that go beyond traditional health care costs. Managed care pharmacists have a responsibility to collaborate with patients, caregivers and other health care professionals to ensure that the use of opioids are prescribed, dispensed, and utilized by patients in an appropriate manner.
Managed care organizations play an important role in the balancing the unique and varied needs of patients who are taking these medications against the probability of addiction, abuse and diversion. Improving the way opioids are prescribed can ensure patients have access to safe and effective treatment while minimizing the risk of opioid use disorder, overdose and death. Therefore, AMCP supports the ability of health plans and pharmacy benefit managers (PBMs) to use managed care tools to safely and effectively manage the use of opioids in a clinically appropriate manner. Pharmacy and Therapeutics (P&T) Committees or drug utilization review (DUR) boards should be empowered along with their health plans to consider the public health and safety impacts of formulary and benefit design decisions in managing the safety, effectiveness, and overall health care costs.
Furthermore, managed care organizations should continue to use well established techniques to prevent the abuse or diversion of opioids for patients who have a history or are suspected of abuse or diversion, such as restricting patients to receiving medications from a single prescriber and/or pharmacy (or chain of pharmacies). These programs have been useful in reducing drug abuse and diversion in at risk patients.
AMCP also continues to support the utilization of prescription drug monitoring programs (PDMPs), also known as prescription monitoring programs (PMPs). PMPs should provide as close to real time prescribing information as technologically feasible and should be interoperable and integrated across state lines. With appropriate HIPAA compliance and protocols, PMPs should also be easily accessible to providers, pharmacies as well as managed care organizations.
Additionally, the U.S. Food & Drug Administration (FDA) is encouraging the development of abuse-deterrent formulations of opioids. While they recognize that these formulations are not abuse- or addiction-proof, they are a step toward products that may help reduce abuse.1 AMCP supports the FDA in this endeavor, as well as supports encouraging manufacturers to undertake reasonable post-marketing surveillance studies to help assess the impact of these products on rates of abuse. These products may vary in their clinical effectiveness and ability to limit abuse potential, and may not prevent addiction when consuming, AMCP supports expanding the ability of managed care organizations to manage these products.
See also:
- AMCP’s position statement on Fraud, Waste, and Abuse in Prescription Drug Benefits; Government‐Mandated Pharmacy Benefits
- AMCP Where We Stand series: https://www.amcp.org/policy-advocacy/policy-advocacy-focus-areas/where-we-stand-position-statements
Revised by the AMCP Board of Directors, November 2020
Approved by the AMCP Board of Directors, June 2013
1. U.S. Food & Drug Administration. Abuse-Deterrent Opioid Analgesics. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/abuse-deterrent-opioid-analgesics. Accessed September 14, 2020.
2. Medicaid and CHIP Payment and Access Commission. Pharmacy and Provider Lock-in Programs in Medicaid Fee for Service. https://www.macpac.gov/wp-content/uploads/2019/08/Pharmacy-and-Provider-Lock-in-Programs-in-Medicaid-Fee-for-Service.pdf. Published June 2020.
3. CDC Expert Panel Meeting Report. Patient Review & Restriction Programs Lessons learned from state Medicaid Program. https://www.cdc.gov/drugoverdose/pdf/pdo_patient_review_meeting-a.pdf. August 2012.