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can’t comment on the policies of Cigna or other health plans, he says Integral Care’s prescribing policy “could per- haps be analogous” to Cigna’s when a controlled substance is involved in treating patients. Those cases require


“a little bit of extra monitoring by the physician,” he said, “whether that’s doing drug screenings, checking the monitoring program, or making sure there aren’t other substances there that could increase the risk of over- dose.” Because Integral Care is a be- havioral health agency, its physicians focus primarily on psychiatric condi- tions rather than pain management. But it does maintain a methadone clinic and prescribes drugs such as buprenorphine for opioid dependence and withdrawal symptoms. “We’ve approached our new pre- scribing practices through education of our staff,” Dr. Nguyen said. “And for the most part, our staff have been re- lieved that they can point towards the prescribing changes policy, or towards sources of education or resources so that they don’t feel pressured to pre- scribe medications they’re uncomfort- able with. “I wouldn’t say it’s decreased pro- N_M^S`S^c Y\ OP MSOXMc K^ KVV 3X PKM^ S^t] perhaps allowed a little more willing- ness to open a conversation about safer alternatives that are still effective.”


EMBRACING NONDRUG TREATMENTS


Those safer alternatives are what some physicians say they’d like to see more health plans authorize and cover more of — treatments such as exercise reha- bilitation and electrical stimulation. Receiving authorization for non- pharmacologic alternative treatments has been “the biggest issue” with re- gard to opioids and pain management, Dr. Hurley says. Physical rehabilitation requires prior authorization, he says, and copays for it can be prohibitive. “Exercise programs such as yoga or


tai chi are not covered,” he said. “In- terventional pain-relieving techniques are limited, and some insurance com- panies reimburse those so poorly that


November 2017 TEXAS MEDICINE 41


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