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State must broaden treatment medication for opioid addiction

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The latest state data on our opioid crisis presents a grim outlook. Despite intensive efforts by lawmakers, health care providers, the criminal justice system and other stakeholders, Arizona appears to be losing the battle to stem the rising number of opioid overdose deaths. Rolling data ending March 1 indicates that 2018 will be our deadliest year on record.

I have a unique vantage point in this epidemic – as an internal medicine/addiction specialist, I am one of the few physicians who treat Arizonans for this disease facilitating their road to recovery. I am also a lawyer who understands that epidemics create unique environments in which unscrupulous profiteers can operate with a level of obscurity clouded by the ongoing “fog of crisis.”he latest state data on our opioid crisis presents a grim outlook. Despite intensive efforts by lawmakers, health care providers, the criminal justice system and other stakeholders, Arizona appears to be losing the battle to stem the rising number of opioid overdose deaths. Rolling data ending March 1 indicates that 2018 will be our deadliest year on record.

Zaheer Shah

Zaheer Shah

I have concerns that the state has been unwittingly complicit in rewarding only certain entities with prescription contracts, which is undermining my ability to provide quality care to my patients. Specifically, Arizona Medicaid has taken a short-sided approach to limit the coverage of vital medications to treat this disease. Today, buprenorphine/naloxone medications are the leading therapies used to treat opioid addiction. While there are multiple FDA-approved buprenorphine/naloxone products available in differing strengths and formulations that may uniquely fit my patients’ needs, Arizona’s Medicaid program only sees fit to cover one product – Suboxone Film.

We need additional treatment options.

My experience tells me that treating addiction must be individualized, based on a wide variety of factors. Only having one “preferred” drug available to treat this epidemic simply falls short of the needs of the few providers treating this epidemic.

Furthermore, requiring a lengthy prior authorization to gain access to the best “non-preferred” medications not only fails to provide these patients much needed treatment on demand (and thereby risking a relapse) – but it puts significant and unnecessary operational strains on my office. The recently released final report by the Trump Commission on the Opioid Crisis called for the coverage of all opioid treatment medications based on a clinical assessment by a qualified professional in consultation with the patient. That position has been echoed by the Kennedy Forum and the addiction experts at the American Society for Addiction Medicine (ASAM). Why is Arizona an outlier?

Furthermore, the manufacturer of this medication, which has garnered great profits through this epidemic, is being sued by more than 40 state attorneys general across the country and is currently under investigation by federal authorities due to a variety of alleged nefarious business schemes designed to extend their patent protections while keeping competitors, including generics, from gaining access to this market. It seems odd that with multiple products now available and with so many state attorneys general suing the current incumbent preferred medication, (not to mention an active federal investigation of the current preferred medication) that Arizona would choose to reward that manufacturer with an exclusive preferred contract.

Arizona Medicaid must provide broad access to all medications in this class – relieving prescribers like me from unnecessary bureaucratic barriers that undermine my ability to treat my patients and the state from being beholden to a single manufacturer with a questionable track record. There happens to be a Pharmacy and Therapeutics Meeting (P&T) scheduled by Arizona Medicaid on April 17, to discuss this very question. Arizona Medicaid can do better. I urge them to do so immediately.

Zaheer Shah is a physician and attorney who practices in Tempe.

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The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.

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