On Monday, the Senate approved a bill to address the opioid epidemic by a vote of 99 to 1. Three months ago, the House passed their own opioid legislative package by a vote of 396 to 14. Both chambers overcame their usual partisan politics to turn 70 separate bills into a comprehensive legislative package that can be enacted before the mid-term elections. Conference discussions have already started, and the goal is to have a final package for President Trump’s signature by Friday, September 28.
While many of the provisions in the House and Senate bills are similar, there are some important differences. In particular, the Senate bill does not include as much funding as the House provisions. Experts in the substance abuse community feel both bills do not include enough money (estimated to require $20 billion a year) to make a dent in the opioid epidemic, which took 50,000 lives last year. One in three Medicare beneficiaries took at least one opioid last year—but at least it’s a start.
“Decreasing access to opioids without appropriate treatment facilities and resources will not decrease the alarming number of deaths in those patients addicted to opioids,” explained Deb Devereaux, Gorman Health Group’s Senior Vice President of Pharmacy Solutions. “Health plans will still need to plan for alternative medications and treatment placements.”
The Senate bill costs $8.4 billion with the funds to be disbursed to multiple government agencies involved in the public health emergency. Common provisions in both bills include funds for the U.S. Postal Service to detect shipments of the deadly synthetic fentanyl drugs, most of which come from China. The bills also include funds for physicians and first responders to have access to more medications to reduce the use of opioids by addicts and provisions for fewer pills in each prescription. “The restrictions on opioid quantity and day’s supply for those new to opioids should decrease the number of addicts, but it is unclear what methods can be used to stop fentanyl, the dangerous and lethal powder coming from China,” continued Devereaux. Both bills require CMS to test a bundled payment model to expand Medicare coverage for opioid treatment programs. The bills mandate electronic prescribing in Medicare Part D for controlled substance prescriptions, and both bills also include more funding for National Institutes of Health (NIH) research.
The Senate bill does not include $1 billion included in the House that will partially overturn the Medicaid Institutions for Mental Disease (IMD) exclusion, which prohibits Medicaid from paying for addiction services in certain inpatient rehabilitation settings with more than 16 beds. The Senate bill does not authorize additional Medicare funding for non-opioid alternatives for post-surgical pain as included in the House bill or the House provision to share more patient medical information. The Senate bill also does not include a provision to require Medicare Part D plans to provide drug management programs for beneficiaries at risk for substance abuse addiction and requiring Medicare and Medicaid managed care plans to implement safety limits for opioid prescriptions and refills. The Senate bill also does not include a provision allowing CMS to waive limits on telemedicine reimbursement for substance abuse and related mental health disorders.
The President is expected to sign the legislation as soon as it arrives on his desk.
Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe