Lindsey Browning Senior Policy Associate, NAMD Medicaid and Prescription Drug Abuse Medicaid National Meeting on Prescription Drug Abuse and Overdose February 1, 2016

Medicaid and Prescription Drug Abuse February 1, 2016 Lindsey Browning Senior Policy Analyst

Overview  Context and Background  Medicaid prevention & treatment pathways  Discussion National Association of Medicaid Directors3

Context and Background National Association of Medicaid Directors4

 Standalone association  56 Medicaid Directors  Mission: o Voice of Medicaid to federal policymakers o Support state-to-state sharing of best practices  NAMD support on prescription drug abuse epidemic National Association of Medicaid Directors5

6 Medicaid and Prescription Drug Abuse  Disproportionate impact on Medicaid beneficiaries New adult population and SUDs Pregnant women and neonatal abstinence syndrome  Social determinants and co-occurring mental illness play major role  Medicaid beneficiaries have 6x the risk of prescription painkiller overdose  Abusers of opioids have costs that are 8x cost of non-abusers

Value of Partnership  Complex problems require comprehensive strategies  Solutions will vary by state  Medicaid policy levers enhanced through collaboration  Each entity brings unique abilities, tools o Data o Staff expertise o Stakeholder engagement National Association of Medicaid Directors7

Prescription Drug Abuse & Medicaid National Association of Medicaid Directors8

9 “Buckets” of Strategies Medicaid Infrastructure Proactive Prevention Measures Active Monitoring and Surveillance Treatment of Addiction Cross-agency and Cross-state Collaborations

National Association of Medicaid Directors10 Medicaid Infrastructure  Provider agreements or contract language  MMIS and other system changes

Proactive Prevention Measures National Association of Medicaid Directors11 Provider education DUR Boards (prospective edits and retrospective reviews) Chronic pain centers Non-pharmacological interventions PREVENTION

National Association of Medicaid Directors12 Active Monitoring and Surveillance  Monitor and address patient use of prescription drugs  Monitor for signs of problematic prescribing or pharmacy concerns  Maximize PDMPs  Enhance lock-in programs

Treatment of Addiction National Association of Medicaid Directors 13  Incentivizing quality and value in SUD services Integrated models Financial reward/risk for outcomes  Other SUD service levers Medication-assisted treatment SBIRT Mental Health Physical Health Substance Use

Cross-Agency and Cross-State Collaboration 14 National Association of Medicaid Directors  Formally or informally collaborate with sister state agencies Joint taskforces, workgroups Monitoring efforts E-prescribing of CII-CV prescriptions  Exchange ideas with other states

National Association of Medicaid Directors15 Recap  Key “buckets” of strategies Medicaid infrastructure Proactive prevention Active monitoring and surveillance Treatment of addiction Cross-agency and cross-state collaboration

Discussion National Association of Medicaid Directors16

 What pathway or strategy have you found most effective?  What bucket of strategies (prevention, treatment, surveillance/monitoring) have been most challenging? Why?  What strategy are you most interested in exploring or enhancing? National Association of Medicaid Directors17

Contact Information Lindsey Browning Senior Policy Analyst National Association of Medicaid Directors National Association of Medicaid Directors18 NAMD/Mercer report: “State Medicaid Interventions for Preventing Prescription Drug Abuse and Overdose.” preventing-prescription-drug-abuse-and-overdose/ preventing-prescription-drug-abuse-and-overdose/