Optimal policies related to ADO’s share the following five key provisions:
- 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);
- 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;
- 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;
- 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,
- 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:
- Sending comments to Drug Utilization Review Boards and Pharmacy and Therapeutics Committees considering the issue. Examples include:
- Providing oral testimony to the FDA as they considered approving new medications.
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