Colorado Medical Society President David Markenson, MD, MBA, submitted comments last week on behalf of CMS on five draft bills under consideration by the Colorado legislature’s Opioid and Other Substance Use Disorders Study Committee. While CMS supports all five bills, and strongly supports efforts to increase access to non-opioid pain care, Markenson raised several points of concern – mostly with the first bill, “Concerning the Prevention of Substance Use Disorders.” He questioned the efficacy of continuing the seven-day opioid prescribing limit indefinitely, asking that the legislature first evaluate the current restriction to understand whether it has reduced opioid-related harm or improved patient care. If there is insufficient data for this analysis, he said, CMS suggests delaying the original repeal date by two years to allow for proper evaluation.
Markenson also encouraged that any limitation on prescribing be accompanied by additional provisions prohibiting health insurance companies, pharmacy benefit managers, pharmacy chains and pharmacists from instituting their own opioid prescribing restriction policies that limit access to appropriately prescribed opioids.
“A prohibition of the corporate influence over the practice of pharmacy would prevent executives of chain pharmacies and other such entities from imposing arbitrary and non-scientific fill limits,” he wrote. “We have seen this at Colorado pharmacies and believe these decisions should be made by the prescriber within the boundaries of the statute and generally accepted standards of care in partnership with their patients, as is best practice for all medical decision making and expected by patients.”
Markenson urged the legislature to work with the health care community to encourage and promote education in schools of professional learning for health care professionals at all stages of their career, rather than implementing a one-time educational mandate on physicians. “A one-time educational mandate will check a box, but it is not the type of foundational experience that will help a health care professional throughout his or her professional practice and establish a lifelong approach to proper practice,” he wrote.
Finally, he urged the legislature to focus on improving the Colorado Prescription Drug Monitoring Program (PDMP) rather than mandating the number of times or circumstances when it must be queried. “Most importantly, the full integration of the PDMP into electronic health records is desperately needed and is the one change that will have the most significant and guaranteed benefit,” Markenson wrote.
“CMS is committed to continuing our active participation and welcomes the opportunity to remain constructively engaged as you move forward with these draft bills,” he concluded.
James Madara, MD, EVP/CEO of the American Medical Association, also submitted comments on the first draft bill, sharing CMS’ concerns about the seven-day opioid analgesic prescribing limit and new mandates for using the PDMP and CME. He also pledged continued support to move the bill forward and specifically praised Colorado’s efforts to remove barriers to alternate pain therapies such as excessive cost sharing, prior authorization or step therapy protocols. He wrote, “Colorado is one of the first states in the nation willing to stand up so strongly for patients who need access to non-opioid pain care options.”
In related news, pain specialist Jonathan Clapp, MD, spoke with Denver NBC affiliate 9News in support of the prevention bill's provisions to change insurance policies to limit out-of-pocket costs and insurance deductibles for patients, making non-opioid pain care more affordable.
"Say a patient comes into my office, and they have a knee problem that could be addressed with physical therapy. If we could work on strengthening and flexibility, we could fix the problem," Clapp told 9News reporter Anusha Roy. "But because it can sometimes cost $80 out-of-pocket for every physical therapy session, it's really hard for someone to afford that."