Got-To-Be M2B: A New Standard of Care in Improving Opioid Access for Minority Patients with Cancer

Key Message: Patients with cancer-related pain encounter significant barriers to opioid access, especially if they live in resource-poor neighborhoods. We developed a systems-based Meds to Bed intervention to provide equitable access to opioid therapy at the time of hospital discharge and to ensure appropriate post-discharge follow-up for ongoing access.

Abstract:

Introduction:
Patients with cancer pain face increasing barriers with access to opioids due to regulatory, insurance, and supply-chain limitations (1, 2). Access is disproportionately limited in minority neighborhoods (3, 4). ‘Meds to Bed’ (M2B) interventions have been shown to improve medication adherence (5). To our knowledge, M2B has not been used to address the opioid access gap. Our hospital’s inter-professional team piloted a M2B intervention to improve opioid access for ethnically diverse patients with cancer at hospital discharge.

Objectives:
Implement new M2B model using inter-professional approach to improve opioid access for minority cancer patients

Methods:
Inter-professional collaborators included Palliative Medicine, Internal Medicine, Pharmacy, Case Management, Nursing, and Social Work. Each discipline contributed to workflow including: targeted provider education on opioid prescribing, communication with pharmacy, prior authorization (PA) completion using CoverMyMeds®, and bedside medication delivery. Monthly PDSA cycles identified workflow improvement opportunities. Patient demographics were obtained by chart review.

Results:
Fifty-seven patients utilized M2B in the first year. The intervention improved opioid access to all cancer patients, with the biggest impact seen in minority groups (70%), particularly those living in areas of NYC known for opioid access issues (60%). The majority (87%) had outpatient follow up within 4 weeks of hospital discharge to ensure ongoing medication access. Key process challenges included: 1) knowledge gaps from providers regarding writing accurate opioid prescriptions, 2) inefficient navigation of PA completion, 3) communication challenges between pharmacies and prescribers. Initiatives to successfully address challenges included: 1) education on accurate opioid prescribing, 2) demonstration and real-time support in CoverMyMeds® utilization, and 3) email/EMR chat between stakeholders for timely troubleshooting.

Conclusion:
Through careful needs assessment, our M2B intervention offers an efficient and sustainable model to improve opioid access for ethnically diverse cancer patients at hospital discharge. This was most impactful for patients living in resource-poor areas of NYC.

References: 1. Schenker Y, Hamm M, Bulls HW, et al. (2021). This Is a Different Patient Population: Opioid Prescribing Challenges for Patients with Cancer-Related Pain. JCO Oncology Practice;17(7):e1030-e1037. doi:10.1200/OP.20.01041

2. Bao Y, Zhang H, Hartung DM, Witkin LR, Paice JA. (2022). Medicare Part D Coverage Restrictions and Patient Cost-Sharing for Opioids Commonly Used for Cancer Pain, 2015-2021. JCO Oncology Practice;18(10):e1574-e1586. doi:10.1200/OP.21.00867

3. Morrison, R. S., Wallenstein, S., Natale, D. K., Senzel, R. S., Huang, L.-L. (2000). “We Don’t Carry That” — Failure of Pharmacies in Predominantly Nonwhite Neighborhoods to Stock Opioid Analgesics. Https://Doi.Org/10.1056/NEJM200004063421406, 342(14), 1023–1026. https://doi.org/10.1056/NEJM200004063421406

4. Hu, J.-C., Chakraborty, P., Zhang, H., et al. (2025). Distribution of opioid analgesics by community racial/[[ethnic and socioeconomic profiles, 2011-2021. Pain. https://doi.org/10.1097/j.pain.0000000000003511

5. Stedge B, Xu J, Kubes JN, et al. (2023). Meds to Beds at Hospital Discharge Improves Medication Adherence and Readmission Rates in Select Populations. Southern Medical Journal;116(3):247-254. doi:10.14423/SMJ.0000000000001532