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Analysis

Trump Expected to Sign Opioids Package Passed by Congress

By MedPage Today  
   October 04, 2018

The legislation includes telehealth provisions, a partial repeal of the Institutions for Mental Diseases (IMD) exclusion under Medicaid, and more.

This article first appeared October 03, 2018 on Medpage Today.

By Joyce Frieden

WASHINGTON — By a vote of 98-1, the Senate approved a package of bills Wednesday to address the opioid crisis, sending the bill to President Trump, who is expected to sign it.

"We have an urgent bipartisan consensus ... to deal with the most urgent public health epidemic facing our country today in virtually every community," said Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor, & Pensions Committee. "Including the appropriations bill passed in March and the bill approved last week, we'll have directed $8.5 billion toward the opioid crisis ... We're not pretending a single act here can fix the problem [but] we want to do everything we can do to provide tools for parents and patients and doctors and nurses and governors and anyone we can find to deal with this crisis."

"The final opioid package represents a critical component" of the fight against opioid addiction, said Sen. Edward Markey (D-Mass.) "But this should not and will not be the end of Congress's efforts." Markey said there were still some "outstanding" issues, "like mandating provider education and labeling opioid bottles on the risk. There are a lot of physicians out there prescribing opioids who have never had [that education] and don't understand what the consequences are. In the absence of that, the cap of the opioid bottle should have a warning."

Some of the provisions in the bill, which the House passed last week, include:

  • Giving Medicare beneficiaries more information on alternative pain treatments, and expanding treatment options for enrollees who are addicted to opioids, while expanding treatment options for opioid-addicted beneficiaries.
     
  • Partially repealing the the Medicaid Institutions for Mental Diseases (IMD) exclusion, which will allow state Medicaid programs to cover inpatient treatment in residential facilities.
     
  • Allowing mothers undergoing addiction treatment to have their young children stay with them, and increasing accessibility of family residential treatment programs, which allows more parents to get help while still caring for their children in a supervised setting.
     
  • Requiring state Medicaid programs to have safety edits in place for opioid refills, to monitor concurrent prescribing of opioids and certain other drugs, and to monitor antipsychotic prescribing for children.
     
  • Directing the Centers for Medicare & Medicaid Services to issue guidance to states on options for providing services via telehealth that address substance use disorders under Medicaid.
     
  • Accelerating the development and use of drug management programs for at-risk beneficiaries within the Medicare program by mandating that all prescription drug plans use such a program by 2022.
     
  • Requiring FDA to develop evidence-based opioid analgesic prescribing guidelines for the indication-specific treatment of acute pain.
     

The American Society of Addiction Medicine (ASAM) was particularly pleased with several provisions in the legislation, including a provision giving new and extended buprenorphine prescribing authority for physician assistants and nurse practitioners, as well as adding pathways for practicing physicians to obtain waivers to prescribe medication-assisted treatment; and loan repayment relief to addiction treatment professionals who practice in high-need areas. The group also welcomed the IMD exclusion's partial repeal.

"ASAM applauds Senate leaders for passing this legislation, which is an important step in ensuring individuals with substance use disorder are able to get the help they need," said Kelly Clark, MD, president of ASAM, in a statement. "Addressing the opioid overdose epidemic will require bold action, including a radical transformation of our treatment system into one that universally teaches, standardizes, and covers evidence-based addiction treatment. We commend Senate leaders for moving us closer toward that goal with today's historic vote."

The American Psychiatric Association also expressed support for the bill, but tempered it with concerns about what was left out. "The APA is grateful to see bipartisan support for increased access to treatment for substance use disorders, including expanded access to residential treatment and medication assisted treatment. We are also pleased to see provisions in H.R. 6 to deter opioid abuse," said APA President Altha Stewart, MD, in a statement.

"However, we are disappointed that the final bill did not include critical reforms to ... improve care coordination and patient safety for the treatment of substance use disorders while preserving patient privacy. This much-needed legislation passed the House earlier this year with overwhelming bipartisan support. We urge the Senate to hold a separate vote on [that legislation] to ensure that these enhanced patient safety, care coordination and consumer protections become law."

The National Community Pharmacists Association (NCPA), a trade group for independent pharmacies, also praised the bill's passage. "The opioid epidemic is a complex, heartbreaking problem requiring an all-hands-on-deck response," said Douglas Hoey, the organization's CEO, in a statement. "We are grateful to congressional leaders for their work on this vital relief package and for engaging with NCPA and other stakeholders throughout its development."

"Among other provisions, the final package includes the NCPA-endorsed Empowering Pharmacists in the Fight Against Opioid Abuse Act, introduced by Reps. Buddy Carter (R-Ga.) and Mark DeSaulnier (D-Calif.), which would require federal agencies to develop and distribute materials to train pharmacists on the circumstances in which they are allowed by law to decline to fill a prescription for a controlled substance," he said. "These circumstances may include the suspicion of fraud, forgery, or other forms of modification."

“There are a lot of physicians out there prescribing opioids who have never had [that education] and don't understand what the consequences are.”


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