Colorado Opioid Task Force

1. Colorado Opioid Task Force Jeff Lalama, Pharm D, BCPS Gina Moore, Pharm D, MBA

2. Program Outline • Introduction/Background • Bills summary • Bill A • Bill B • Overview of the remaining bills • Wrap-up/Questions

3. Introduction/Background • Approximately 17,000 people die each year in the US from opioid overdoses • 300 deaths in Colorado • “One of the four most serious epidemics facing the nation” per the CDC • Colorado was #2 in the nation in 2010-2011 for non-medical uses of prescription painkillers (#15 in 2017) • 83% increase in Colorado newborns addicted to opioids • Heroin use in Colorado has also risen dramatically

4. Colorado opioid-related deaths Frank, J. Colorado’s opioid epidemic explained in 10 graphics. The Denver Post, 11/6/2017

5. Opioid and Other Substance Use Disorders Interim Study Committee • Interim task force convened by the Colorado legislature • Bipartisan representation • Met several times over the summer • CPS represented by Jeff Lalama and Gina Moore, who provided formal testimony • Six bills came out of the interim committee to be introduced in the upcoming legislative session

6. Bill Topics • Bill A – Prevention of opioid misuse • Bill B – Clinical practice measures for safer opioid prescribing • Bill C – Measures to address opioid crisis in Colorado • Bill D – Expand access to behavioral health providers • Bill E – Medicaid inpatient and residential substance use disorder treatment • Bill F – Payment issues relating to substance use disorder treatment

7. Bill A – Prevention of Opioid Misuse • Section 1 – Creates opioid and substance use disorder study committee • Section 2 – School-based health center grant program • Section 3 – Grants for organizations dealing with substance abuse • Section 4 – Continuing education programming for pain control and opioid use

8. Opioid and Substance Abuse Study Committee • Committee responsibilities • Study data and statistics on scope of substance abuse disorders in Colorado • Study resources available to Coloradans for prevention, treatment, and recovery • Review availability of medication-assisted treatment and if pharmacists can help through collaborative practice agreement • Examine other states and countries to determine best practices for treating substance use disorders and prescription drug monitoring • Identify gaps and hurdles for resources available to Colorado • Identify legislative options to address gaps and hurdles identified

9. Opioid and Substance Abuse Study Committee • Bipartisan committee comprised of 5 members from both the senate and house of representatives • May meet up to 6 times per calendar year • May introduce up to 6 bills for the 2019 and 2020 legislative sessions • Committee will be repealed on July 1, 2020

10. Continuing Education • Center for research into substance use disorder prevention, treatment, and recovery shall develop continuing education activities: • Help prescribers safely and effectively manage pain, prescribe opioids or medication assisted treatment when appropriate • Training for law enforcement and first responders for using opioid antagonists to treat overdoses • Community-based training for people at risk of opioid overdose • Center will be appropriated $750k from the marijuana cash fund to develop these activities • Section will be repealed on September 1, 2019

11. Opioid Bill B – Quantity Limits The bill restricts the number of opioid pills that a health care practitioner, including physicians, physician assistants, advanced practice nurses, dentists, optometrists, podiatrists, and veterinarians, may prescribe for an initial prescription to a 7-day supply and one refill for a 7-day supply, with certain exceptions.

12. Opioid Bill B – Quantity LimitsCPS Survey Results

13. Opioid Bill B – Quantity Limits Current exceptions to the 7-day supply • “past the time of normal healing” • “is the result of an underlying medical condition, disease, injury, medical treatment, or inflammation, or an unknown cause, any one of which may become progressively worse or recur intermittently” • “cancer-related pain” • “experiencing post-surgical pain expected to last more than 14-days” • “is prescribed a drug with an added abuse-deterrent”

14. Opioid Bill B – Quantity LimitsCPS Survey Results

15. Opioid Bill B – PDMP Requirements Current law allows health care practitioners and other individuals to query the prescription drug monitoring program (program). The bill requires health care practitioners to query the program before prescribing the first refill prescription for an opioid except under specified circumstances, and requires the practitioner to indicate his or her specialty or practice area upon the initial query

16. Opioid Bill B – PDMP Requirements Current law allows health care practitioners and other individuals to query the prescription drug monitoring program (program). The bill requires health care practitioners to query the program before prescribing the first refill prescription for an opioid except under specified circumstances, and requires the practitioner to indicate his or her specialty or practice area upon the initial query

17. PDMP Integration and Provider Report CardsCPS Survey Results

18. PDMP Integration and Provider Report Cards • CDPHE tasked with reporting out data from “Prescription Drug Overdose Prevention for States Cooperative Agreement” previously received federal grant • Due on or before September 1, 2019 • Data includes: • PDMP Integration methods • Provider report cards • Center for Research Into Substance Abuse Disorder Prevention, Treatment, and Recover Support Strategies to use data to develop voluntary training

19. Bill C – Measures to Address Opioid Crisis in Colorado • Designates hospitals may be used as a clean syringe exchange site • Civil immunity for participants of clean syringe exchange programs • Supervised injection facility pilot program in the city and county of Denver • Allows schools to obtain opioid antagonists and train employees on administration for someone at risk of experiencing a drug overdose • Requires commission on criminal and juvenile justice to study sentencing related to opioid-related offenses

20. Bill D – Expand Access to Behavioral Health Providers • Colorado Health Service Corp program modifications: • Allows primary care office to develop and administer state health professional shortage areas • Allows behavioral health care providers loan repayment programs on condition of providing care in health professional shortage areas for a specified period • Advisory council to prioritize loan repayment and scholarships • Establishes a scholarship program • Adds 2 members to the council to review program applicants • Appropriates $2.5 million from marijuana cash fund annually to provide loan repayments and scholarships

21. Bill E – Medicaid Inpatient and Residential Substance Use Disorder Treatment • Adds residential and inpatient substance use disorder services to the Colorado medication assistance program • Benefit limited to patients meeting criteria for residential and inpatient substance use disorder treatment • Benefit will not become effective until federal authorizations and federal financial participation in the program are obtained

22. Bill F – Payment Issues Relating to Substance Use Disorder Treatment • Requires all health benefit plans to provide coverage without a prior authorization for a 5-day supply of buprenorphine for first request within a 12-month period • Physical therapy, acupuncture, or chiropractic services shall not be given less favorable coverage than primary care services if the patient has a diagnosis of chronic pain or substance use disorder • Patient satisfaction surveys with pain treatment cannot solely be used by a carrier to take adverse actions or financial incentives/disincentives to a provider • Permits a pharmacist entering a collaborative practice agreement to administer injectable medication-assisted treatment for substance abuse disorders and receive an enhanced dispensing fee

23. Bill F – Payment Issues Relating to Substance Use Disorder Treatment • Prohibits step therapy by using an opioid before covering a non-opioid • Requires Colorado medical assistance program to authorize reimbursement for a ready-to-use intranasal version of naloxone without prior authorization • Requires establishment of rules standardizing utilization management authority timelines for non-pharmaceutical components of medication-assisted treatment for substance use disorders

24. Future Advocacy • Committee will be active for another 2 years (if Bill A passes) • Continuing education not currently mandatory • Many moving pieces, depends on version of bills that ultimately get passed

25. Questions? ?