In the face of a highly partisan political environment, addressing the opioid crisis is one issue that has consistently received broad bipartisan support during the 115th Congress. According to government estimates, drug overdose deaths are rising in America, killing over 64,000 people in 2016. Deaths from prescription opioids are being rapidly eclipsed by those from heroin and deadlier synthetic opioids like fentanyl.
The past two years have seen a flurry of bipartisan action from Congress to address America’s opioid crisis. More than 280 opioid-related bills have been introduced during this Congress in both the House and Senate. These efforts culminated in a sweeping bipartisan effort to consolidate many of these individual efforts into a massive legislative package, H.R. 6, the SUPPORT for Patients and Communities Act (PL 115-271). The bill’s provisions affect stakeholders across the healthcare system including manufacturers, providers, publically-sponsored plans and government agencies. It also includes many law enforcement provisions.
Many provisions of the bill would have an impact on the ability of providers to prescribe opioids to their patients. Illegal drugs such as heroin are responsible for much of the crisis. However, more than 40 percent of overdose deaths involved prescription opioids.
One way the bill changes prescription practices is by limiting the number of pills allowed per prescription. Specifically, the bill authorizes the Food and Drug Administration (FDA) to require manufacturers to distribute certain opioids in packs containing 3-7 day supply of pills. Sometimes patients receive prescriptions that include more pills than they need. This will help reduce over-prescriptions or prescription abuse.
With regard to the Medicare program, The Centers for Medicare and Medicaid Services (CMS) will also be required to include information about opioid addiction and alternative pain management treatments in the Medicare and You handbook provided to Medicare beneficiaries.
Medicare providers will also be required to screen Medicare beneficiaries for substance abuse disorders and review opioid prescriptions during a patient’s initial Medicare visit or annual wellness visit.
The bill requires CMS to identify outlier prescribers of opioids and provide them with education on proper prescribing practices. CMS will determine a threshold for what is considered an outlier prescription rate.
H.R. 6 also creates a new Medicare bundled payment model for substance abuse treatment. It also waives a Medicare geographic requirement to expand access to telehealth services for substance abuse treatment.
Additionally, beginning January 1, 2021, all Medicare opioid prescriptions must be transmitted using an electronic “e-prescription.” This will improve the ability of policy makers to track prescriptions to identify over-prescribers. The bill also requires CMS to track patients who are at risk of opioid addiction and will make this information to providers.
The opioid crisis has taken an enormous toll on the Medicaid population. According to statistics from the Kaiser Family Foundation, Medicaid covers 40 percent of nonelderly adults with opioid addiction. Medicaid enrollees are more likely than uninsured or privately insured adults to be receiving treatment for substance use disorder.
However, federal Medicaid policy has limited the ability of state Medicaid programs to cover short-term inpatient substance abuse treatments. The Federal government will not provide a match to states for inpatient substance abuse treatment provided at institutions for mental disease (IMD) with more than 16 beds. H.R. 6 temporarily lifts this restriction and allows federal matching for substance abuse treatments IMD facilities with more than 16 beds.
Prescription Drug Monitoring Programs (PDMP) will be another central strategy for using technology to prevent over-prescriptions. PDMPs track opioid prescriptions and allow providers access to a patient’s prescription history. This can prevent patients from seeing multiple providers for the same condition and therefore receive multiple prescriptions.
Eleven states have established PDMPs with much success. Following the passage of a law in Florida that mandated the use of PDMPs by prescribers, Florida saw a 52 percent reduction in opioid-related deaths and a 24 percent reduction in prescriptions for certain drugs. The average Morphine Milligram Equivalents (MME) per person decreased 80 percent across the state. Ohio and Kentucky saw similar results after their state adopted laws mandating the use of PDMPs.
The bill incentivizes states to adopt PDMPs by authorizing funding and enhanced Medicaid matching rates for states that adopt PDMPs. The bill also will require Medicare Part D drug plans to utilize PDMPs.
Looking ahead to the next Congress, the opioid crisis should continue to be a central focus of health policy. Federal agencies will also begin issuing regulations to implement the provisions of H.R. 6. Agencies will have the authority to determine key details for how many of these policies will be structured. The opioid crisis will not be solved overnight and certainly will not be solved by one legislative effort.