As expected, the Virginia General Assembly met last month in “pro forma” session and promptly recessed, indicating the Commonwealth has yet to pass a two-year budget. It was announced that a biennial budget might be ready by June, signaling that it could be months before a compromise is reached.
I have worked as a women’s health nurse practitioner in private practice and served in many elected, appointed, and volunteer positions, including as a two-term member of the Radford City Council, and was appointed by two different governors to the Department of Professional and Occupational Regulations and the Board of Nursing.
In over two decades in public service, the lesson that has stayed with me is a simple one: people should not have to fight the system to get what is right. When they do, it is usually because somewhere along the way, a policy stopped reflecting common sense and nobody fixed it.
That is exactly what has happened in Virginia. Non-opioid pain treatment should be addressed by including Item 291 #11s in the final budget.
Here is the problem in plain terms. When a Medicaid patient in Virginia is prescribed a non-opioid medication for pain, the system can require that patient to first try two other drugs and document that both failed — a process called step therapy — before the non-opioid option is even considered for coverage. There may also be other forms, reviews, more delays. It can take weeks. Meanwhile, if the patient receives a prescription for an opioid, it goes through. No required failures first. No waiting. Virginia is one of the most restrictive states in the country when it comes to these barriers on non-opioids — and one of the most permissive when it comes to opioids. That combination is not an accident of history we can ignore. It is a policy we need to change.
I know families across this Commonwealth who have lost someone to opioid addiction. Many of those stories started the same way — with a prescription, written in good faith, for pain. We have spent years and hundreds of millions of dollars trying to address the damage that followed. This amendment is about prevention. It is about making sure that when a doctor and a patient decide a non-opioid is the right choice, the state does not put obstacles in their way that do not exist for the more dangerous option.
Virginia saw nearly 2.8 million Medicaid opioid prescription claims in 2021 alone — among the highest rates in the country. At the same time, the FDA has approved a growing number of non-opioid treatments that manage pain without addiction risk. We know these options exist. But if getting coverage means weeks of paperwork and mandatory detours that a simple opioid prescription does not require, many will take the path the system clears for them. That is human nature. And right now, we are on the wrong path.
The language in the amendment does not tell doctors what to prescribe. It does not mandate coverage for any particular drug or override the judgment of the Pharmacy and Therapeutics Committee. What it does is straightforward: it says that whatever hoops exist for a non-opioid pain medication cannot be more restrictive than what exists for an opioid. Equal treatment. Nothing more. The committee retains its authority. Physicians and healthcare providers retain all of theirs. We are simply removing the state’s thumb from the scale.
The cost to the Commonwealth is nothing. The potential savings — in reduced addiction treatment, in lives not derailed, in families that stay whole — are very real. This is the kind of people-centric policy I came to Richmond to fight for. The budget negotiators should include this amendment, and the governor should sign it. Anyone who has watched this crisis touch their community should know that we saw the gap, and we closed it.
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