The Senate and House have agreed to a compromise opioid bill HR 6, the SUPPORT Act, that has passed the House and is expected to pass the Senate this week and be signed into law by the President. This is the second big piece of legislation Congress has created to address the opioid crisis, with a total of 660 pages.
“The bill does include a number of positive provisions from a pain management perspective, but also continues a troubling pattern in recent legislation of penalizing the use of opioids for legitimate pain management,” said Cindy Steinberg, U.S. Pain National Director of Policy and Advocacy.
On the positive side, there is a focus on improving access to and education about nonopioid pain treatment options, particularly for Medicare beneficiaries, through new Center for Medicare and Medicaid Services guidance documents. These documents will specify what nonopioid pharmacological and nonpharmacological treatments will be covered. Patients will be provided with education on non-opioid treatments for pain at the annual “Medicare Wellness” doctor’s visit and through a Food and Drug Administration public meeting to address barriers to the development of nonaddictive medical products for acute and chronic pain.
There is a provision requiring the Department of Health and Human Services (HHS) to submit a report to Congress on how to improve public payers’ reimbursement and coverage for multidisciplinary, evidence-based, nonopioid chronic pain management. The legislation adds tasks to the job of the Interagency Pain Research Coordinating Committee, the highest-ranking permanent pain policy committee in the United States, in several ways, including identifying gaps in research on pain biomarkers and the epidemiology of acute and chronic pain. Two members of U.S. Pain staff presently sit on this committee.
Finally, the Secretary of HHS–in consultation with the Attorney General–must submit a report to Congress on the impact of federal and state limits to the length, quantity, or dosage of opioid prescriptions on the incidence and prevalence of overdose related to prescription and illicit opioids, the prevalence of opioid use disorders, and the access to and medically appropriate use of opioids.
There are a number of provisions throughout the bill aimed at severely restricting or even eliminating the prescribing of opioids for Medicare and Medicaid beneficiaries with chronic, non-cancer pain. One provision requires the HHS Secretary to establish thresholds for opioid prescribing and annually flag, notify, and provide “technical assistance” to “outlier prescribers.” Beneficiaries of Medicare Advantage plans, Part D prescription plans, and Medicare initial physical and annual wellness visits who are found to have current opioid scripts must receive information on the risks of continued opioid use, as well as be screened for opioid use disorder.
In addition, the survey that goes to Medicare patients asking about their recent hospital stay called Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHPS, may not include questions about communication by hospital staff about pain–unless such questions take into account whether a patient experiencing pain was informed about the risks of opioids and about non-opioid alternatives for pain management.
Medicaid programs also are now required to employ Drug Review & Utilization techniques for opioids that track, flag, and limit any scripts that exceed a state established daily MME ceiling dose for chronic pain patients.
The bill is expected to pass this week. If you have concerns about how these provisions may impact your pain care, contact your federal lawmakers.