January 30, 2019
Statistics regarding the current opioid crisis in the U.S. continue to indicate cause for alarm in comparison to previous years. According to the National Institute of Drug Abuse, a subset of the U.S. National Institutes of Health (NIH), an estimated 115 people in the U.S. die every day from opioid-related overdoses as of March 2018. The data shows that this is a massive uptick from previous years, fueled by pain relievers like oxycodone, fentanyl and street drugs like heroin. The NIH also reports that 21-29 percent of patients who are prescribed opioids abuse them.
The epidemic was declared a public emergency in the U.S. in 2017, which marked the beginning of some promising legislative and monetary efforts to curb opioid misuse. Mid-year in 2017 the approved federal budget included $6 billion allocated to address the opioid epidemic, $3 billion to be used in 2018 and the remaining $3 billion for 2019.
Former Attorney General Jeff Sessions also made the initiative a priority, developing the Prescription Interdiction & Litigation (PIL) Task Force. Sessions developed the PIL Task Force to aggressively enforce current legislation and hold pharmaceutical companies, clinics and doctors accountable. It has also taken on improving regulatory efforts to ensure these entities are complying with existing laws.
A comprehensive bill signed into law on October 2018 included changes to existing public health programs, like Medicaid and Medicare, that will increase access to treatment for addicts. The bill also supports research for non-addictive alternatives to opioids for pain management, lowers barriers for patients seeking addiction treatment and requires the FDA to refuse approval of any new drugs made with a controlled substance and show a high likelihood of patient misuse.
It received strong bipartisan support, easily clearing the House with a vote of 396 in favor versus 14 opposed and flew through the Senate, with a vote of 98 in favor versus one opposed. It’s an encouraging sign that lawmakers have agreed to lend legislative support in the form of funding, time and resources to help cut down on opioid dispersion and help addicts receive treatment.
The bill also makes specific changes to Medicaid and Medicare, demanding that The Centers for Medicare & Medicaid Services (CMS) “must establish a demonstration project to increase provider treatment capacity for substance-use disorders.” It also requires both programs to increase funding allocated to patients utilizing home health services for substance use disorders.
For Medicare specifically, prescriptions containing controlled substances for patients must be monitored by submitting them through electronic prescription programs, enabling doctors to see who has prescribed the patient opioids. This targeted law aims to prevent “doctor-shopping,” a practice often used by active opioid addicts. The bill also requires sponsors of Medicare’s prescription drug plans to develop drug management programs, and that patient’s health plans include coverage for services from certified opioid and addiction treatment providers.
At Advanced Medical Reviews, our drug utilization reviews offer an ongoing assessment of how providers prescribe based on evidence-based guidelines. These reviews include medical necessity of drugs to potential interaction of multiple medications. As a URAC-accredited independent review organization, we aim to ensure appropriate provider prescription behavior and positive patient outcomes regarding opioid use. Read more about the opioid crisis and other healthcare news on the AMR blog.
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