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Physicians Urge Removal of Prior Authorization Barriers, Adherence to Parity Laws

The American Medical Association (AMA) adopted policy at its Annual Meeting to ensure that patients with substance use disorders receive evidence-based treatment - whether that treatment is in clinics, drug treatment facilities, hospitals, correctional settings or the physician's office.

"The AMA wants all physicians to be leaders in the fight against the opioid epidemic," said AMA President-elect Patrice A. Harris, M.D., chair of the AMA Opioid Task Force. "This means they must fight to end stigma surrounding substance use disorder and medication assisted treatment (MAT), which has been shown to decrease overdose mortality, reduce transmission of infectious disease, and reduce general health care expenditures."

The AMA urges removing administrative barriers to MAT, including prior authorization that causes delays or denials of care. The AMA also urges enforcement of mental health and substance use disorder parity laws. Only 10 percent of patients with a substance use disorder receive the necessary treatment, and the AMA urges all stakeholders to help reduce these barriers.

The AMA has extensive policy, backed by the work of the AMA Opioid Task Force, to help end the opioid epidemic. The AMA website, endtheopioidepidemic.org, offers nearly 400 resources and educational material for physicians on a wide range of issues including prescribing opioids appropriately, starting patients on MAT, using naloxone and safe storage and disposal of opioids.

Delegates approved the following policies that directed the AMA to:

• Advocate for legislation to ensure that patients have access to all FDA-approved medications or therapies in all settings such as drug treatment clinics or facilities. It also called for a public campaign to increase awareness that medical treatment of substance use disorder with MAT is a first-line treatment for this chronic medical disease. MAT is an evidence-based treatment that is effective and should be available as part of any treatment for substance use disorder.

• Work with the American Hospital Association and other relevant organizations to identify best practices to treat opioid use disorder as a chronic disease. The groups will identify patients with this condition; initiate or provide opioid agonist or partial agonist therapy in inpatient, obstetric and emergency department settings; provide cognitive and behavioral therapy as well as other counseling; establish appropriate discharge plans, including education about opioid use disorder; and participate in communitywide systems of care for patients and families affected by this chronic medical disease. It also called for the AMA to advocate for states to evaluate programs that have received government funding to assist physicians, hospitals and their communities to coordinate care for patients with opioid use disorder.

• Advocate for the expansion and improved access to evidence-based treatment for substance use disorders during pregnancy. The AMA has longstanding policy strongly supporting that pregnant women should not be penalized for having a chronic medical disease, including a substance use disorder. Delegates said the AMA should continue resisting efforts to criminalize substance use disorder by leveling criminal penalties or punitive measures against those with this chronic disease.

• Ensure medical students, physicians-in-training, and practicing physicians receive education on opioid prescribing. The policy calls for the AMA to develop opioid education resources in conjunction with the Association of American Medical Colleges, American Osteopathic Association, Commission on Osteopathic College Accreditation, Accreditation Council for Graduate Medical Education and other interested professional organizations.