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Issue Background

Abuse Deterrent Formulations

SPPAN Position

Optimal policies related to ADO’s share the following five key provisions:

  1. Require insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for abuse-deterrent opioid analgesic drug products (ideally as many types of insurers as possible);
  2. Prohibit the insurers, nonprofit health service plans, and health maintenance organizations from imposing certain limits or cost-sharing requirements on coverage for ADOs that are less favorable to an insured or an enrollee than the limits or cost-sharing requirements that apply to coverage for any other opioid analgesic drug product;
  3. Prohibit the insurers, nonprofit health service plans, and health maintenance organizations from requiring an insured or an enrollee to first use a certain drug product before providing coverage for an ADO;
  4. Prohibit the insurers, nonprofit health service plans, and health maintenance organizations from increasing certain cost-sharing requirements or other out-of-pocket expenses to achieve compliance with the above requirements, and further, prohibit the creation of a financial disincentive for a prescriber or dispenser to prescribe or dispense an ADO; and,
  5. Authorize the insurers, nonprofit health service plans, and health maintenance organizations to utilize prior authorization for an abuse-deterrent opioid analgesic drug product so long as the prior authorization requirements are the same as those used for non-abuse-deterrent opioid analgesic drug products.

Action Examples: Written & Oral Testimony

Letter of Support re: Maine LD 919 (2015); bill passed and became effective 1/1/2016.

Letter of Support re: Colorado HB 1214 (2015); bill passed and became effective 3/20/2015.

In addition to supporting ADO legislation, we also supported the availability and affordability of ADOs by:

Resources:

Abuse-Deterrent Opioids — Evaluation and Labeling. U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER).  April 2015.

Fact Sheet – FDA Opioids Action Plan.  September 2016.

FDA Facts: Abuse-Deterrent Opioid Medications.  January 2017.

Status of Abuse-Deterrent Opioid Analgesics.  Center for Lawful Access and Abuse Deterrence.  January 2017.

Commentary: Abuse-Deterrent Opioids: Who Needs Them, and at What Cost?  Partnership for Drug-Free Kids, February 4, 2015, by Bob Twillman, PhD, FAPM

Abuse-deterrent formulations show promising signs of reducing the incidence of the most dangerous and potentially deadly form of abuse. They should be available when needed, at a reasonable cost.