Implementing new policies or changing existing ones supports the application of applying best practice and current research towards fighting the opioid epidemic. This page provides a few examples of policy changes that have been made to work toward making changes in California.
The California Department of Public Health's (CDPH) State Public Health Officer issued a Standing Order for Naloxone to allow entities to disseminate and administer Naloxone to reduce deaths associated with opioid overdose. In alignment, the California Board of Pharmacy implemented a new law allowing pharmacists to distribute Naloxone without a prescription. Additionally, the California Department of Health Care Services (DHCS) removed Treatment Authorization Requirements (TARs) under Medi-Cal for buprenorphine/naloxone products.
Smart Care California developed a checklist of health plan (PDF) approaches for safe prescribing based on the most up-to-date evidence emerging from literature review, case studies, interviews, and surveys of California Health Plans. The plan focuses on four priority areas: prevent, manage, treat, and stop deaths.
Additionally, the California Budget Act of 2019 includes $15.2 million in funding for Syringe Services Programs (SSPs) over four years (July 1, 2019 through June 30, 2023), as well as funds for technical assistance and support dollars for managing the program. Of the total, $12.6 million will support staffing at SSPs (granted to individual SSPs through an RFA process), $1.8 million will support technical assistance and program administration (granted to an outside organization), and $800,000 (over four years) will support staffing at CDPH/Office of AIDS.
Department of Health Care Services
The California Department of Health Care Services (DHCS) has implemented multiple policy changes between 2013-2017 to increase access to Naloxone, Buprenorphine, and alternative pain treatment in the MediCal (Medicaid) program. One such change, removing the Treatment Authorization Request (TAR) requirement for the drug Buprenorphine, resulted in a 50% increase in MediCal Buprenorphine prescriptions from 2015 to 2016
Within the Medi-Cal System, DHCS has implemented policies to address opioid overdose and addiction, including:
- Adding Naloxone to Medicaid formulary (July 1, 2013)
- Adding Buprenorphine to Medicaid Formulary as a "carve out" medication (June 1, 2015)
- Removal of the requirement for Treatment Authorization Request (TAR) for Buprenorphine
- Removal of all methadone products from the contract drug list for pain management (May 2016)
- Adding nasal Naloxone to the contract drug list (October 1, 2016)
- Re-institued acupuncture as a Medi-Cal managed care benefits (July 2016)
The DHCS Pharmacy Branch Division (PBD) is responsible for DHCS' Medi-Cal fee-for-service (FFS) drug program and for the management of the Medi-Cal managed care pharmacy program.
PDB recently added commercially available Naloxone nasal spray to the Medi-Cal Contact Drug List, which resulted in a 153% increase in Naloxone claims since 2015 (there has been a 51% increase in buprenorphine claims in this time period). The PBD looks to continue the forward momentum on implementation of naloxone distribution and buprenorphine access in high risk communities in the state.
Pharmacy Board Policy Changes
The California State Board of Pharmacy (CSBP), through emergency regulations, made Naloxone available through pharmacists without a prescription. Additional CSBP regulations were created and implemented to allow California pharmacies to establish drug-take back services so the public can rid their homes of unused drugs through collection receptacles or the mail.
At the local level, there are Emergency Departments (EDs) and Urgent Care facilities who have set restrictions on the number of days (3 days) as well as the number of pills that will be given for home use after an ED visit.
For example, all of the EDs within the Hospital Association of San Diego & Imperial Counties (HASDIC) – all agreed to the same standards, including: VA Hospital Medical Center, Tri-City Medical Center, Scripps Chula Vista Hospital, Kaiser Hospital, Camp Pendleton ED, and Alvarado Hospital, to name just a few.