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Resident’s opioid-related efforts become TMA priority

Jul. 22, 2021, 9:47 AM


by Emily Stembridge

Leah Jesse, MD, a Psychiatry resident, successfully brought an anti-stigma resolution to the floor of the Tennessee Medical Association (TMA) House of Delegates meeting in May.

Leah Jesse, MD

The resolution, co-written by Jesse and medical student Noah Harrison, will now be considered a TMA priority in the next legislative season.

If passed in the upcoming legislative season, their resolution would abolish the requirement of prior authorizations for buprenorphine-naloxone (also known as Suboxone) for patients with TennCare in their first two years of treatment for opioid use disorder (OUD).

Medications like buprenorphine-naloxone are essential to treating OUD and preventing overdose.

As a member of the legislative committee and chair of the resident and fellow section of the TMA, Jesse is frequently in attendance at TMA meetings.

This year, she and a group of medical students realized there were no opioid-related issues brought to the committee. The lack of opioid-related legislation was motivation to draft their prior authorization legislation.

“The opioid crisis is a major issue in the state of Tennessee, but unfortunately it’s started to take a back seat in terms of public attention due to COVID-19, even though numbers show that use and overdoses are worsening,” Jesse said.

Prior authorizations can be a burden to getting patients the medications they need to treat OUD, with paperwork often causing days-long delays. Three-page-long forms are needed to complete a prior authorization, and any small mistake means the authorization will be rejected.

For patients in withdrawal, this can mean a higher risk of overdose or death if they return to substance use during the delay.

Prior authorization paperwork historically also requires physicians to agree that they will halve a patient’s dosage of buprenorphine within six months of beginning usage, a goal that Jesse says is unrealistic for many patients.

“It’s not evidence based,” she said. “Many of our patients will require this as a life-long treatment. There are a lot of hoops you have to jump through to help patients remain on this medication. The next step we’re hoping for is passing this on a legislative level and making this medication easier to obtain for patients.”

“It’s so wonderful to see our psychiatry residents like Dr. Jesse making a meaningful impact on public policy dialogue through the TMA,” said David Marcovitz, MD, assistant professor of Psychiatry and Behavioral Sciences and director of the Division of Addiction Psychiatry.

“With the TMA’s support, we hope Tennessee will join the more than 21 states that have limited the ability of public and private insurance to impose prior authorizations on services and medications for substance use disorders.

“Simply put, this is a smart policy supporting better health outcomes and cost savings based on the experience of several other states,” he said.

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