As lawmakers consider legislative strategies to curb the opioid epidemic, the White House March 19 released the president’s plan to address the public health emergency by reducing excessive prescribing, promoting evidence-based addiction treatment and recovery support services, and reducing the supply of illicit drugs.
Specifically, the White House plan will include a public awareness campaign, as well as support for research on new therapies for addiction and non-addictive pain management options. Additionally, the plan recommends a “Safer Prescribing Plan” to reduce opioid prescribing by one-third within three years through the use of “best practices” for 75 percent of opioid prescriptions reimbursed by federal health care programs, and other strategies.
The plan also seeks to expand access to Medication-Assisted Treatment (MAT) and to “provide on-demand, evidence-based addiction treatment to service members, veterans, and their families” through the Departments of Defense and Veterans Affairs. The White House also calls on Congress to eliminate the Medicaid Institutions for Mental Disease (IMD) exclusion, which prohibits Medicaid reimbursement for inpatient care at certain facilities. The Department of Health and Human Services has been approving Medicaid waivers to suspend the exclusion in the interim.
Meanwhile, Congress continues to explore potential legislation to address the epidemic. The House Energy and Commerce Committee held a two-day hearing March 21-22, examining 25 bipartisan public health bills, including legislation to provide additional flexibility to the National Institutes of Health (NIH); to support educational Centers of Excellence; and to create a loan repayment program for substance use disorder treatment providers, among others.
And AAMC President and CEO Darrell G. Kirch, M.D., responded in a March 19 letter to a Feb. 28 request from leaders of the House Ways and Means Committee for input on potential policy recommendations.
The letter highlights the work medical schools and teaching hospitals are doing in their communities to improve prevention and treatment of pain and addiction through their missions of research, education, and patient care. Noting the disproportionate level of care provided by AAMC-member teaching hospitals, the letter also emphasizes, “These institutions serve on the front lines of the country’s safety net, investing in a wide scope of mental and behavioral health services, including treatment and recovery support for substance use disorders.”
At the same time, however, the letter describes challenges in making progress against increasing numbers of opioid overdoses, in part “because this crisis is layered on top of existing public health and social services deficits, further straining the health care and public health infrastructure.” To help address some of these challenges, the AAMC recommends:
- Improving coverage and payment for non-opioid alternatives to treat pain;
- Enhancing usability of Prescription Drug Monitoring Programs;
- Reducing access challenges by addressing physician shortages across multiple disciplines;
- Supporting efforts to promote MAT, including reducing hurdles for qualified physicians to prescribe MAT, exploring comprehensive payment models to better support and incentivize clinicians to co-manage patients undergoing MAT, and removing reimbursement barriers to MAT;
- Enforcing parity by implementing the Mental Health Parity and Addiction Equity Act, eliminating Medicare limits on inpatient psychiatric hospital treatment, and eliminating the Medicaid IMD exclusion;
- Aligning privacy regulations to ensure providers have access to information they need to care for patients with substance use disorders;
- Investing in research, including support for the NIH and the Agency for Healthcare Research and Quality, and reauthorization of the Patient-Centered Outcomes Research Institute; and
- Supporting grants to enhance provider and patient education.
The letter also encourages the committee to be mindful of potential unintended consequences that could arise from well-intended policies, describing existing disparities among patient populations who historically have been undertreated for pain, as well as challenges associated with recent shortages of injectable opioid medications.