Dr Kelly Clark Describes How Payers Can Increase Patient Access to Medication-Assisted Therapy

According to Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine, payers and pharmacy benefit managers can aid in patient access to the medication they need to treat addictive disease by ensuring an evidence-based prior authorization protocol, just as they would for a patient with a chronic disease.

Transcript (slightly modified)

How can payers and pharmacy benefit managers help to expand medication-assisted therapy to patients?

Pharmacy benefit managers can help their members access appropriate buprenorphine treatment by ensuring that their prior authorization protocols are really evidence-based.

Examples of evidence-based prior authorization requirements would be around required psychosocial interventions like diversion control protocols or contingency management protocols that are spelled out in the ASAM (American Society of Addiction Medicine) national guidelines for the use of medications in treating opioid use disorders.

Things that are not evidence-based would be things like requiring forced tapers or putting a lifetime limit on coverage. We don’t do that with any other chronic disease, and it makes no clinical sense to do that with the disease of addiction or the use of these medications.

Other things that aren’t evidence-based would be requiring patients to remain sober from other drugs of abuse like marijuana or cocaine. Think of it in this way: a patient may have, or a member may have cardiovascular disease. They may have high blood pressure and high cholesterol; they’re prescribed a beta-blocker and what’s found is, in fact, their blood pressure comes down but their cholesterol doesn’t. We don’t say, “Well, you still have active cardiovascular disease so we’re not going to cover your beta-blocker anymore.” We don’t expect the beta-blocker to do anything for cholesterol.

That’s how we should think of buprenorphine for a person with an addictive disease, who may be addicted to opioids, may be abusing or even addicted to another substance.