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 Congressional Hearings Examine Medicare, Medicaid Opioid Crisis Roles

Hearings addressing dozens of legislative proposals to help stem the nation’s opioid crisis continued this week in Congress, with one subcommittee alone reviewing some 34 bills over two days, many of which focused on how the Medicare and Medicaid programs can better track and curtail these drugs while treating beneficiaries.

Opioids and how to handle the need for pain relief for residents while limiting exposure to these highly addictive drugs is of keen importance to long term and post-acute care providers, as well as all stakeholders along the care continuum.

Rep. Michael Burgess, MD (R-Texas), chair of the House Energy and Commerce Committee’s Health Subcommittee, which reviewed the 34 bills, said the issue demands new ways of thinking on “how to help strengthen Medicaid and Medicare’s ability to combat the scourge of opioid abuse, because without adequate tools and accountability, our largest public payers will be unable to handle the challenge before them.”

The key witness to appear before the panel was Kimberly Brandt, principal deputy administrator for operations, Centers for Medicare & Medicaid Services (CMS), who told lawmakers that the number of Americans struggling with an opioid use disorder (OUD) is staggering.

“In 2016 alone, nearly 64,000 Americans died from drug overdoses, the majority (over 42,000) of them involved opioids,” she said.

Brandt said CMS recently finalized a series of changes for 2019 to further the goal of preventing OUDs. To reduce the potential for chronic opioid use or misuse, beginning in 2019, the agency expects all Part D sponsors to limit initial opioid prescription fills for the treatment of acute pain to no more than a seven days’ supply. 

“This policy change is consistent with the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain that states that opioids prescribed for acute pain in most cases should be limited to three days or fewer, and that more than a seven-day supply is rarely necessary,” she said.

There are also measures to increase safety edits, which alert a pharmacist of possible overutilization at the point of sale. Other actions have been taken to reduce opioid misuse without restricting access to legitimate services, like in the Medicaid program, which is utilizing medical management techniques such as step therapy, prior authorization, and quantity limits.

The ranking Democrat on the subcommittee, Rep. Frank Pallone (N.J.), said there are many ways to attack the opioid crisis through the Medicare and Medicaid programs, including how to relieve barriers to lifesaving treatment, like Naloxone and other medication-assisted treatments.

He said there is also legislation under consideration regarding the role of Medicare Parts B and D to address the rising epidemic of opioid over-prescription and misuse among seniors. “For example, we will discuss legislation under Medicare Part B to expand opioid disorder treatment options through telehealth and also legislation under Part D to ensure ‘e-prescribing’ is utilized when prescribing controlled substances,” Pallone said.

Seniors-focused bills are important because evidence suggests that opioid use among older adults is a significant and growing problem. “According to the OIG [Office of Inspector General] more than 500,000 Part D beneficiaries received high amounts of opioids in 2016, with the average dose far exceeding the manufacturer’s recommended amount,” Pallone said.

Stressing that lawmakers need to think of a mix solutions for stemming the crisis, he said he has significant concerns regarding a proposal to add a pain assessment to the Welcome to Medicare physical. “While well-intentioned, I am concerned that this bill could actually exacerbate our opioid crisis. I have heard from numerous stakeholders in the medical community that a similar approach adopted by the Joint Commission in 2001 to treat pain as a ‘fifth vital sign’ actually contributed to the opioid epidemic,” Pallone said.

By requiring health care providers to ask every patient about their pain, and giving incentive to aggressive pain management, these measures may have resulted in the overprescribing of opioids, he said.

Republican leaders on the full Energy and Commerce Committee hope to have a final bipartisan package ready for a House floor vote in the coming months.​
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