Federal Updates on Addressing Opioid Abuse Epidemic

The North Carolina Medical Society (NCMS) is keeping close tabs on the discussions taking place in Washington, D.C. around how best to address the opioid abuse epidemic.

Last week, Ways and Means Committee Chairman Kevin Brady (R-TX) and Ranking Member Richard Neal (D-MA), along with Health Subcommittee Chairman Peter Roskam (R-IL) and Ranking Member Sander Levin (D-MI), to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma regarding ways to address and prevent opioid abuse in the Medicare Part D program. NCMS leadership meet recently with Rep. Brady to discuss this issue among others. [See Bulletin article on this meeting.]

The committee’s letter highlights recommendations presented during two Ways and Means Committee hearings related to the opioid epidemic, and the Committee leaders state that the proposals “represent important steps [the] agency can and should take to continue responding to this national emergency.”

Specific proposals/suggestions cited in the letter include:

  • The Members request more information on CMS’ proposal that “a sponsor may not limit an at-risk beneficiary’s access to coverage of frequently abused drugs to a selected prescriber(s) until at least six months has passed from the date the beneficiary is first identified as a potential at-risk beneficiary.”  They ask CMS to provide information on how it determined 6 months to be an “appropriate” length of time and to consider condensing this timeframe without limiting beneficiary appeal and notice rights
  • The Members encourage CMS to expand its Overutilization Monitoring System to include additional, non-controlled drugs that are susceptible to fraud, waste and abuse, in line with an Office of Inspector General recommendation
  • The leaders encourage CMS to “evaluate [its] current process to determine the best pathway for plans to share reports of abuse and determine what type of additional information from plans, if any, would be the most beneficial to curb opioid misuse.”
  • The Members state their support for “widespread utilization of lock-in programs” in Part D, in line with an OIG recommendation
  • The Members note that CMS has proposed that beneficiaries who are locked-in would no longer be eligible for the special enrollment period (SEP) that they would otherwise be able to use. The Members suggest that there should be an exceptions process for the forfeiture of SEP to protect beneficiary access
  • The Members recommend that CMS ensure that beneficiaries are aware of their right to appeal, as well as the option of automatic escalation, to ensure beneficiaries have quick resolution on coverage issues
  • The Members request more information on CMS’ proposed “four pharmacy test” to determine whether a beneficiary is at risk, including how CMS determined the number and the average number of pharmacies used by beneficiaries
  • The Members urge CMS to “consider pharmacists as part of the Part D plan’s case management for at-risk or potentially at-risk beneficiaries.”

The letter states that, given the “severity of the crisis” and issues identified by the OIG and Government Accountability Office, the Members request a detailed response by March 23, 2018. Read the letter.

From the White House

The White House has created a page dedicated to the opioid crisis, available here, which details the actions taken by the Trump Administration to quickly “answer this growing threat.”  The page includes materials such as the November 2017 report from the President’s Commission on Combating Drug Addiction and the Opioid Crisis; a November 2017 report from the White House Council of Economic Advisors on the “underestimated cost” of the opioid crisis; and the October 2017 Presidential Memorandum for the heads of Executive Departments and Agencies to use “all appropriate emergency authorities” to “combat the drug demand and opioid crisis currently afflicting our country.”

Additionally, the US Department of Health and Human Services (HHS) has a page that includes data on HHS’ “5-point strategy to combat the opioid crisis,” which details information such as HHS’ efforts to improve opioid-related data and research. It also includes statistics related to the epidemic.

Free Opioid CME

In an effort to be sure all providers are able to obtain their required opioid CME’s a free voucher is available for those unable to attend an onsite training. This FREE CME is approved for up to 3 hours of category 1 CME with AAFP, AMA/AAFP Equivalency, and CDE.


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