1. Maryland Cancer Plan Pain Management Committee Suzanne A Nesbit, PharmD, BCPS Clinical Coordinator, Cancer Pain Service Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

2. Ideal Model for Cancer Pain Assessment and Management Cancer pain is a serious public health challenge Access & Advocacy –Pain management needs of uninsured Rights and Responsibilities –All parties involved Diversity Extension to all pain –Cancer pain consists of acute and chronic pain

3. Education and Training Lack of provider awareness and training regarding assessment, management and regulations All disciplines should receive didactic and clinical training Educate the licensing boards Statements from licensing boards about each disciplines’ role in pain management All providers required to earn CE in pain assessment and management

4. Reimbursement Mandate that insurers in Maryland provide a pain assessment and management benefit Inpatient and outpatient referrals to a pain specialist Follow up care Reimbursement for all treatment modalities Malpractice insurance discount for providers completing education in pain management

5. Health Care Systems Lack of consistency within health care systems Compliance and adherence to standards Non-JCAHO accredited facilities should follow same standards Reduce limitations to prescribing pain and side effect medications in extended care facilities

6. Access to Pain Management Prior authorization system creates delays for patients Independent council to improve process Extend assistance for payments to 250% of poverty levels Opioids and other pain medications should be readily available in pharmacies

7. Legislation Lack of legislation to ensure the right and provision of pain assessment and management Review Advanced Directive and Living Wills forms to improve clarity Include patient preference for effective pain control Modify regulations to facilitate availability and prescribing of pain medications

8. Legislation Develop Pain Patient’s Bill of Rights Future legislation should be balanced concerning opioid use Utilize American Alliance of Cancer Pain Initiatives Statement on State Prescription Monitoring Programs

9. Other Key Issues Public information and education Complementary and alternatives therapies Assessment Adherence Conclusions –Maryland State Advisory Council on Pain Management