Impact of the Opioid Crisis Response Act

On October 24, 2018, President Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities, or the SUPPORT for Patients and Communities Act. This bill, referred to as the Opioid Crisis Response Act, will have direct impacts on an array of areas within pharmacy and healthcare settings including The Centers for Medicare and Medicaid Services (CMS), the states themselves, naloxone prices, and patient education.

Some of the provisions from the bill that will impact pharmacy include:

  • Prescriptions for controlled substances that are covered drugs under Medicare must be transmitted through electronic prescription programs
  • Medicare prescription drug plan sponsors must establish drug-management programs for at-risk beneficiaries
  • Each state must establish a qualifying prescription drug monitoring program (PDMP) and require health care providers to check the PDMP for a Medicaid enrollee’s prescription drug history before prescribing controlled substances to the enrollee
  • CMS must report on the adequacy of access to abuse-deterrent opioid formulations for individuals with chronic pain enrolled in a prescription drug plan under Medicare or Medicare Advantage (MA)
  • CMS must provide Medicare beneficiaries with educational resources regarding opioid use and pain management, as well as descriptions of covered alternative (non-opioid) pain-management treatments
  • CMS must develop an action plan to provide recommendations on changes to the Medicare and Medicaid programs to enhance the treatment and prevention of opioid addiction, as well as coverage and payment of medication-assisted treatment
  • CMS must also publish a report that includes an evaluation of price trends for opioid overdose-reversal drugs (e.g., naloxone) and recommendations on ways to lower consumer prices for such drugs
  • The bill also establishes criteria for individuals who are identified as at-risk beneficiaries for prescription drug abuse as qualifying participants in medication therapy management (MTM) programs under the Medicare prescription drug benefit
  • Medicare and MA prescription drug plan sponsors must annually disclose information to enrollees about the risks of prolonged opioid use, as well as coverage of nonpharmacological therapies, devices, and non-opioid medications

Many of these measures aim to improve patient education about the dangers of opioids and encourage the use of opioid alternatives. In 2017 alone, nearly 50,000 overdose deaths relating to opioids occurred. Educating patients through services such as MTM and suggesting alternative pain management therapies could go a long way in reducing that number. The bill also provides increased access to treatment for opioid addiction as well as other provisions all aimed at reducing opioid related deaths and protecting patients. CMS has released a tip sheet for preventing and combating opioid overuse as well as new opioid related policies in Medicare D beginning in 2019. More information can be found at https://www.cms.gov/Medicare/Prescription-Drug-coverage/PrescriptionDrugCovContra/RxUtilization.html

PHSI believes that while the passage of this bill plays a pivotal role in beginning to address the crisis, additional legislation is required to continue to slow and resolve the opioid epidemic. For example, requiring prescribers to electronically prescribe controlled substances for all patients would force adoption of the two factor authentication and minimize controlled substance diversion through paper prescriptions. The SUPPORT Act is one important component in a multifaceted plan to address the opioid crisis.  PHSI expects that the opioid epidemic will continue to be a relevant issue in both pharmacy and healthcare settings. The coming months will provide valuable insight into just how much of an effect the Opioid Crisis Response Act can have.

Posted: January 2019

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