The Management of Opioids
Where We Stand:
Opioid analgesics have proven to be very effective in controlling short and long‐term pain due to a large number of causes. These drugs are also the most commonly abused medications in the United States, reaching epidemic levels. The Academy ofManaged Care Pharmacy (AMCP) is deeply concerned both about the proper management of patients suffering from uncontrolled pain, as well as limiting abuse and diversion of opioids, because the improper use of opioids carries enormous costs to our society that go beyond traditional health care costs. Managed care pharmacists have a responsibility to work with patients and other health care professionals to ensure the appropriate use of opioids and to ensure that prescriptions are dispensed and utilized for legitimate medical needs.
Managed care organizations must carefully balance the unique and varied needs of patients who are taking these medications against the probability of abuse and diversion. Therefore, AMCP supports the ability of health plans and pharmacy benefit managers (PBMs) to use managed care tools to effectively manage the use of opioids in a clinically appropriate manner. Medicaid pharmacy and therapeutics (P&T) committees or drug utilization review (DUR) boards should be empowered to consider the public health and safety impacts of formulary coverage decisions in addition to effectiveness and cost.
Furthermore, managed care organizations should not be restricted from using well established techniques to prevent the abuse or diversion of opiates 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 proven successful in reducing drug abuse and diversion in the commercial and managedMedicaid markets. Unfortunately, Medicare Part D plan sponsors are prohibited from restricting pharmacy and provider access for “at risk” patients. This undermines patient care and encourages greater diversion. AMCP supports sensible changes to existing law to allow for the use of these successful programs inMedicare Part D programs.
AMCP also continues to support the development and implementation of 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 and to managed care organizations.
Additionally, promising advancements in technology have resulted in the further development of “tamper resistant” or “abuse deterrent” formulations of certain opioids. This has served as another strategy in combating abuse and diversion. These formulations are designed to make it more difficult for abusers to crush, chew, snort or inject the products, which has previously been common practice by abusers. It is important to note that while there is no such thing as a tamper‐proof product, there is a limited, but increasing, field of research suggesting the potential these products have in reducing the overall rates of abuse and diversion. There is also empirical data indicating these products have a “reduced street value” due to the difficulty of converting them into an abusable product. Since these products may vary in their clinical effectiveness and ability to limit abuse potential, AMCP supports expanding the ability of managed care organizations to manage these products.
Finally, AMCP encourages the U.S. Food and Drug Administration (FDA) to use its expertise to establish standards for the definition of “abuse‐deterrent” and “tamper resistant.” The agency should also mandate that manufacturers undertake reasonable post‐marketing surveillance studies that will help assess the impact of the products deemed abuse‐deterrent or tamper‐ resistant on both the abuse of the specific product, as well as overall rates of abuse.
AMCP’s position statement on Fraud, Waste, and Abuse in Prescription Drug Benefits
AMCP Where We Stand series: https://www.amcp.org/policy-advocacy/policy-advocacy-focus-areas/where-we-stand-position-statements
Approved by the AMCP Board of Directors, June 2013