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  • AGs From 37 States Call for Better Insurance Coverage for Nonopioid Pain Treatment

    Attorneys general (AGs) from 37 states have let the insurance industry know that the fight against the nation's opioid crisis won't be won unless health care providers are encouraged to prioritize nonopioid pain management options, including physical therapy, over opioid prescriptions for the treatment of chronic, noncancer pain. But that encouragement won't have much impact unless it's accompanied by payment coverage policies that make the nonopioid approaches more feasible to pursue, they write.

    In a letter to America's Health Insurance Plans (AHIP), the health insurance industry's trade association, AGs affiliated with the National Association of Attorneys General describe the opioid crisis as "the preeminent public health crisis of our time." The AGs say that while addressing addiction and recovery are crucial components in solving the problem, the issue must also be addressed further upstream—namely in the ways opioids are overused as a treatment for pain.

    "The unnecessary over-prescription of opioid painkillers is a significant factor contributing to [the opioid epidemic]," write the AGs. "When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective non-opioid alternatives, ranging from non-opioid medications…to physical therapy, acupuncture, massage, and chiropractic care."

    The AGs write that the needed encouragement must come through insurance company incentives to follow a nonopioid treatment path. "Simply asking providers to consider providing alternative treatments is impractical in the absence of a supporting incentive structure," they write. "All else being equal, providers will often favor those treatment options that are most likely to be compensated."

    Besides helping to reduce the prevalence of opioids, nonopioid pain treatment is consistent with the science around pain management, according to the AGs. "Incentivizing opioid alternatives promotes evidence-based techniques that are more effective at mitigating this type of pain, and, over the long run, more cost efficient," they write. "Thus, adopting such policies benefits patients, society, and insurers alike."

    In a September 22 response, AHIP stated that its members "continue to expand and refine a comprehensive, multi-faceted approach to preventing and managing opioid misuse and related conditions," including "identifying alternative forms of pain management." The AHIP letter lists several member initiatives, including a push by Anthem to encourage providers to follow opioid prescription guidelines from the US Centers for Disease Control and Prevention. AHIP also states that it's working with some members on "exploring and improving access to non-pharmacologic pain treatments that have been proven effective in reducing pain."

    The AHIP letter also asserts that medical management—prior authorization, prescription tiering, plans that require "an evidence-based systematic approach to therapy," and the like—is 1 of the "most effective tools health plans have" in the battle against opioids, and has been mischaracterized as a "barrier" to treatment.

    "To effectively solve the opioid crisis, it must be addressed comprehensively by all stakeholders—from law enforcement and the justice system, to social services agencies and state Medicaid programs, to health care providers, pharmacists, health plans, and pharmaceutical companies," AHIP writes. "Only through collaboration and cooperation can we address—and solve—this crisis, and further improve efforts for prevention, education, intervention, and treatment."

    APTA's award-winning #ChoosePT campaign is aimed at informing consumers that physical therapy is an effective alternative to drugs for the treatment of pain. Housed at MoveForwardPT.com/ChoosePT, #ChoosePT includes a video public service announcement, as well as other targeted advertising and media outreach. Members can also learn more about the PT's role in pain management through offerings on PTNow, including a webpage with resources for pain management and an opioid awareness checklist.

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    • I have Been on Opiates for years now and just recently had an overdoes do to chronic low back and leg pain. As of right now i am trying to get a spinal cord stimulater so that i can stop taking the Hydro's but the fight with the insurance company is making it hard to have a good outlook on things. all i have asked for the last 6 years is to not be in pain and after a failed back surgery with nerve damage that goes all the way down my left leg makes it hard to take care of my 4 children. my insurance company is denying me this Trial to get off the opiates. i think it is sick that there are people working for these company's looking for key words that will deny the procedure.i asked the name of the "Dr." that is employed by the insurance company looking at my case and all i got was the name when i asked what this "dr.'s" credentials are i got no answer. how can someone that does not even specialize in that field make a decision about what is good for the individual.

      Posted by Emily McGinley on 6/7/2018 2:40 PM

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