April 11, 2018
Medical management tools are a critical piece of ensuring patients receive safe, effective, and affordable care based on scientific evidence. These types of tools include:
As the industry works to tackle the opioid epidemic, these tools have become increasingly important when addressing pain management, reducing unnecessary opioid prescribing, and treating opioid use disorder (OUD).
When administering pain medication, plans, physicians, and pharmacists work closely together to educate and inform patients and prevent future opioid abuse. Some examples of how medical management might be applied to the treatment of pain and opioid prescribing include:
Health insurance providers also want to ensure comprehensive treatment programs are available and accessible for those suffering from addiction. For example, one widely recognized and recommended therapy is medication assisted treatment (MAT), which helps patients overcome their substance use disorder through medications like methadone, buprenorphine, and naltrexone, along with services such as cognitive behavioral counseling, peer support services, and community-based support groups. Medical management plays an important role here to ensure effectiveness, adherence, and holistic treatment of the patient. For example:
In 2016, the Centers for Disease Control and Prevention (CDC) issued a Guideline for Prescribing Opioids for Chronic Pain for primary care physicians that includes medical management recommendations such as using non-opioid and non-medication pain care as a first line of therapy, prescribing the lowest dose and fewest opioids that would be effective for each patient, regularly reviewing the risks associated with opioids with patients, and closely monitoring patients to promote safer use and better outcomes.
Medical management works. It works to ensure everyday clinical practice is consistent with safe, evidence-based care. And it works to stave off the ever-growing opioid crisis. In fact, a recent study found that enrollees within Medicaid plans that use prior authorization have lower rates of abuse and overdose following initiation of opioid medication treatment.5 Preserving and protecting medical management will be an essential part of ongoing efforts to address the opioid crisis and the persistent challenges to safety, quality, and affordability.
2 Wide Variation and Over Prescription of Opioids After Elective Surgery. Thiels CA, et al. Annals of Surgery. October 2017.
3 High-Risk Medications in Hospitalized Elderly Adults: Are We Making It Easy to Do the Wrong Thing? Blackman N, et al. Journal of the American Geriatrics Society. November 28, 2016.
4 Opioids in Medicare Part D: Concerns about Extreme Use and Questionable Prescribing. HHS OIG Data Brief OEI-02-17-00250. U.S. Department of Health & Human Services. Office of the Inspector General. July 2017.
5 Medicaid Prior Authorization and Opioid Medication Abuse and Overdose. Cochran G., et al. The American Journal of Managed Care. May 2017.