CMS Strategy to fight the Opioid crisis

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CMS Strategy to fight the Opioid
crisis
The COVID-19 pandemic has taken a devastating
toll on Americans across the country, whether in
lives lost or economic impacts, and it has
particularly affected our fellow citizens who
have the most vulnerabilities, including the
elderly and communities of color. CMS forced to
adjust and adapt our daily lives in innumerable
ways, while significant public health resources
have had to be redirected to help us meet and
beat this unprecedented pandemic. In 2018,
President Trump signed the Substance Use-Disorder
Prevention that Promotes Opioid Recovery and
Treatment for Patients and Communities Act, or
the SUPPORT for Patients and Communities Act,
into law, which mobilized Federal efforts to
address the nations ongoing opioid crisis.
Section 2003 of the SUPPORT Act mandates that the
prescribing of a Schedule II, III, IV, or V
controlled substance under Medicare Part D should
be done electronically in accordance with an
electronic prescription drug program, beginning
2021, subject to any exceptions, which the
Department of Health and Human Services (HHS) may
specify. The circumstances that are listed in
the statute under which the Secretary may waive
the EPCS requirement are at section 1860D-4(e)(7)
of the Act, as added by section 2003 of the
SUPPORT Act, and include
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CMS Strategy to fight the Opioid
crisis

• A prescription issued when the practitioner and
  dispensing pharmacy are the same entity
• A prescription issued that cannot be transmitted
  electronically under the most recently
  implemented version of the National Council for
  Prescription Drug Programs SCRIPT Standard
• A prescription issued by a practitioner who
  received a waiver or a renewal thereof for a
  period of time as determined by the Secretary,
  not to exceed one year, from the requirement to
  use electronic prescribing due to demonstrated
  economic hardship, technological limitations that
  are not reasonably within the control of the
  practitioner, or other exceptional circumstance
  demonstrated by the practitioner
• A prescription issued by a practitioner under
  circumstances in which, notwithstanding the
  practitioners ability to submit a prescription
  electronically as required by this subsection,
  such practitioner reasonably determines that it
  would be impractical for the individual involved
  to obtain substances prescribed by electronic
  prescription in a timely manner, and such delay
  would adversely impact the individuals medical
  condition involved
• A prescription issued by a practitioner
  prescribing a drug under a research protocol
• A prescription issued by a practitioner for a
  drug for which the Food and Drug Administration
  requires a prescription to contain elements that
  are not able to be included in electronic
  prescribing, such as a drug with a risk
  evaluation and mitigation strategies that include
  elements to assure safe use
• A prescription issued by a practitioner

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CMS Strategy to fight the Opioid
crisis
CMS recently announced a proposed rule for
Medicaid (CMS-2482-P) that builds on current
policies to help ensure that opioid prescribing
is appropriate, medically necessary, and avoids
adverse medical events.  The proposal would
address a requirement in the SUPPORT for Patients
and Communities Act (the SUPPORT Act) that states
have systems in place to identify or limit
inappropriate prescribing of opioids under
certain conditions, such as if a beneficiary is
already receiving medication-assisted treatment
for substance use disorder (SUD). Were also
seeking input from Medicaid stakeholders on
proposals for future rulemaking that would
require additional review of opioid prescribing,
medication-assisted treatment and naloxone
prescribing. CMS has taken a number of steps to
identify and stop inappropriate prescribing to
help prevent the development of new cases of OUD
while balancing the need for continued access to
prescription opioids for appropriate,
individualized pain management. For example, the
SUPPORT Act requires all Medicare Part D sponsors
to have a Drug Management Program (DMP) for plan
years beginning on or after January 1, 2022. As
of January 2020, 87 of Part D plans have already
implemented a voluntary DMP. Thanks to policies
promoting safer opioid use, the percent of
Medicare beneficiaries receiving higher than
recommended doses of opioids declined by 45
between 2016 and 2019.
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CMS Strategy to fight the Opioid
crisis
As CMS enhanced their prevention activities,
theyve also made great strides in expanding
access to evidence-based OUD treatment. As of
January 2020, for the very first time, Medicare
covers methadone furnished by opioid treatment
programs (OTPs) for beneficiaries suffering from
OUD. This new benefit will also cover other OUD
treatment services as part of a bundled
payment. These services include dispensing and
administration of medications used in
medication-assisted treatment (MAT) substance
use counseling toxicology testing as well as
intake activities and periodic assessments.
Additionally, the coverage includes substance use
counseling and individual and group therapy
services furnished by OTPs either in-person or
via two-way interactive audio-video technology,
which broadens access to these critical services
particularly for those living in rural areas that
have been among the hardest hit by the opioid
crisis. CMS coverage policies now ensure some
form of MAT across all CMS programs. Starting
January 1, 2020, for the first time, Medicare cove
rs methadone for MAT and related
services furnished by opioid treatment programs
(OTPs). On January 21, 2020, Medicare
coverage expanded to include acupuncture for
certain beneficiaries with chronic low back pain.