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Insurers are the gatekeepers for patients in the U.S. and Colorado for affordable, and hence, accessible treatment.  Tragically, insurance providers have made it difficult (and often impossible) for providers to create safe and effective treatment plans (in lieu of cheaper, more dangerous and easily abused opioids) for patients struggling with pain.  Multiple studies, state & federal governmental agencies, hospital accreditation agencies, physician organization guidelines and other sources of evidence are unified in describing the efficacy and safety of a multi-modal approach to pain and avoiding (or limiting as much as possible) opioid pain medications.  Prior authorizations (or “prior auth’s”, “PA’s” or “prior permission”), developed by insurance companies in the interest of cost saving, create much more work for providers and physicians and serve as a deterrent to procure what we know is critical for our patients. 

Therefore, we are unified in stating that it is critical for insurers to allow us easy and affordable access (without prior authorizations, "step therapy" or "fail first" restrictions) to well-studied and effective non-opioid treatments like pain psychology, physical therapy, judicial interventional procedures and non-opioid pain medications (ex. pregabalin, celecoxib & lidocaine patches).  We also require the same conditions for coverage of safer and less abused atypical opioids including buprenorphine (transdermal patch & buccal film) and tapentadol (extended- & immediate-release).  When “true opioid” medications (that are often abused) like oxycodone, hydrocodone, fentanyl, dilaudid and morphine are required for severe pain, we physicians and providers call for quick approval (that is affordable and exempt from prior authorizations) of at least one abuse-deterrent formulations (ADF’s) of a specific “true opioid” medication (ex. 1 ADF oxycodone, 1 ADF hydrocodone, 1 ADF morphine, etc.) due to their efficacy in decreasing tampering, abuse and diversion.  We hope that having one approved medicine for each molecule will establish competition among pharmaceutical manufactures and resulting lower costs for insurers.  We are aware these medications can be costly, and we support limiting costs as much as possible, while still protecting Coloradoans.  Life-saving naloxone needs to be available to all “high-risk” patients, patients who receive opioids with benzodiazepines and patients who are prescribed doses > 50 morphine equivalents to reverse opioid-overdoses and deaths, as is recommended in the latest DORA opioid prescribing policy.  Affordable addiction treatment is paramount to recovery and needs to be covered universally.  Lastly, urine toxicology screens (with confirmatory screens including metabolites due to the poor accuracy of rapid screens) provides essential insight into the behaviors and safety of patients on opioids so that we can treat them appropriately. 

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