May 16, 2019
Commission votes on two proposals regarding chronic pain coverage
The Health Evidence Review Commission (HERC) today voted unanimously to update Oregon Health Plan (OHP) coverage for neck and back pain, by removing requirements for opioid tapering. The change will be effective October 1.
Meanwhile, the HERC unanimously declined to cover treatments for the five chronic pain conditions that had been under consideration since 2017, citing a lack of evidence of clinical effectiveness for both non-pharmacologic and pharmacologic treatments for those conditions.
The five conditions under consideration were: chronic pain due to trauma, post-procedural chronic pain, chronic pain syndrome, other chronic pain, and fibromyalgia.
In 2017 OHA convened the Chronic Pain Task Force to explore whether OHP should cover these five chronic pain conditions. Currently, they are not intended to be covered by OHP. The proposal that was informed by the task force garnered considerable concern and attention from advocates, providers and experts across the country, prompting deeper dives into the evidence and revisions to the proposal. Most recently, OHA commissioned a third-party review by Washington-based Aggregate Analytics Inc. (AAI) to appraise the evidence under consideration for these chronic pain conditions.
"The HERC is often faced with important decisions with limited clinical evidence available," said Dana Hargunani, M.D., chief medical officer at OHA. "We want to thank the members for their thoughtful deliberations. We are committed to reviewing new forthcoming evidence ahead."
Previously in 2016 the HERC expanded OHP coverage for neck and back pain, newly approving non-pharmacological services such as physical and occupational therapy, chiropractic care, cognitive behavioral therapy, acupuncture and yoga. The benefit package had also required opioid tapering neck and back pain patients from long-term opioid therapy.
Today the HERC voted to remove the tapering requirement if not clinically indicated. The neck and back pain coverage will be further revisited this winter, with a focus on opioid coverage.
"Pain is complicated and different for everyone," said Kevin Olson, M.D., HERC chairman. "We heard loud and clear that pain treatment and opioid tapering should be individualized based on the patient-clinician relationship. I am pleased that we were able to align the neck and back coverage with these principles."
About the HERC
The Health Evidence Review Commission reviews medical evidence to prioritize health spending in the Oregon Health Plan and to promote evidence-based medical practice statewide through comparative effectiveness reports, including coverage guidances and multisector interventions, health technology assessments and evidence-based practice guidelines.
The commission consists of 13 governor-appointed and senate-confirmed volunteer members, including five physician representatives (one of whom must be a doctor of osteopathy and another a hospital representative), a dentist, a public health nurse, a behavioral health representative, a provider of complementary and alternative medicine, a retail pharmacist, an insurance industry representative and two consumer representatives.
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