Managed Healthcare Executive: Pharmacy experts discuss opioid utilization and addiction treatment for managed care

March 29, 2017

The Opioid Therapeutic Class Management Workgroup, which UMass Medical School developed for a state Medicaid program, is featured in a Managed Healthcare Executive article about opioid utilization strategies for managed care organizations. This workgroup model was presented at the Academy of Managed Care Pharmacy's Managed Care & Specialty Pharmacy Annual Meeting on March 28.

“What our program does [at University of Massachusetts Medical School] that I feel is fairly unique is use our multidisciplinary team to collaborate with prescribers on appropriate opioid utilization,” said Tyson Thompson, PharmD, a clinical consultant pharmacist in UMass Medical School’s Clinical Pharmacy Services.

Thompson and Kimberly Lenz, PharmD, clinical pharmacy manager in UMass Medical School's Office of Clinical Affairs, presented the workgroup during their March 28 AMCP session, “Tackling the Opioid Epidemic and Addiction Treatment: A Managed Care Approach.”

The workgroup comprises a practicing internist who serves as medical director, a clinical pharmacy manager, a board-certified psychopharmacology pharmacist, an operations pharmacist and two clinical consultant pharmacists.

Thompson explained that the workgroup meets to discuss problematic use patterns in individual or group practices, as well as complex member cases that arise from the opioid prior-authorization process. Individualized plans are created for members to address specific issues, and often include prescriber outreach to gather more information or propose alternative pain management strategies.

The workgroup goes beyond traditional opioid management strategies that include quantity limits or restrictions on using specific types of opioids, which Thompson said could impede access to appropriate pain medication.

Lenz ended the AMCP presentation with recommendations from the AMCP Addiction Treatment Advisory Group (ATAG), of which she is a member.

“Our objectives are to identify areas with the greatest potential to significantly improve patient outcomes, develop recommendations to remove barriers, improve processes and modify systems that allow for improved outcomes, and serve as advocates in adopting our recommendations, including the development of educational programs,” Lenz told Managed Healthcare Executive.

Breaking down organizational barriers to treatment is important to improve access, Lenz said. One thing to consider, she said, is ensuring guidelines are evidence-based.

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