APS E-News | Advocacy Update Report | November 2018
H.R. 6 Becomes Law
Now named the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (“SUPPORT”) for Patients and Communities Act, its enactment brings to a close the legislative phase of a massive undertaking by multiple committees in both chambers of Congress.
Here are some key provisions summarized by the Pain Care Coalition:
- Medicaid Program Integrity: Section 1004 expands current state Medicaid drug utilization review activities by requiring Medicaid programs to implement safety checks to monitor opioid refills, concurrent opioid prescriptions, and antipsychotic medications prescribed to children. Medicaid providers will also be required to check relevant prescription drug monitoring programs before prescribing a Schedule II controlled substance and must also report all PDMP data and information to CMS (Section 5042).
- Electronic Prescribing for Medicare Drugs: Starting in 2021, all prescriptions for a Schedule II, III, IV, or V Controlled Substance covered under a Part D prescription drug plan or MA prescription drug plan will be required to be transmitted in accordance with an electronic prescription drug program established under Section 1860D of the Social Security Act.1 Exceptions will be made for situations such as economic hardship or when the prescribing practitioner and dispensing pharmacy are the same entity (Section 2003).
- Identifying At-Risk Beneficiaries: All prescription drug plans within the Medicare program will be required to develop and implement a drug management program for at-risk beneficiaries. Other provisions require Medicare Part D plans to classify any beneficiary with a history of opioid-related overdose as “at-risk.” Part D beneficiaries will be able to appeal this designation to an external entity (Section 2007).
- Prescribing Guidelines: The Food and Drug Administration (FDA) is required to develop opioid analgesic prescribing guidelines for acute pain treatment. The FDA will consult stakeholders and gather public input when developing these guidelines. The guidelines will be intended only to inform clinical decision making and are not meant to deny or restrict access to healthcare treatments (Section 3002).
- Increase Access to Medication-Assisted Treatment: Section 3201 increases the number of qualified healthcare providers that can prescribe or dispense buprenorphine, a well-known medication-assisted treatment (“MAT”). This provision authorizes clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists to prescribe MAT. Qualified physicians will now be able to prescribe MAT to as many as 100 patients upon becoming board-certified, and up to 275 patients 1 year after receiving the initial waiver.
- Outlier Providers: Under Section 6065, the Department of Health and Human Services will be required to notify and provide resources to providers who prescribe opioids above a threshold limit when compared to prescribers within the same specialty and geographic location. HHS is charged with establishing the threshold limits for outlier prescribers. However these thresholds will be determined based on informal consultation with stakeholders and could become a backdoor way for Medicare to implement prescribing guidelines.
- Pain Management Study: HHS is required to submit a report to Congress on how to improve reimbursement and coverage for multi-disciplinary, evidence-based, non-opioid chronic pain management. The report must include options for improving treatment and case management strategies for various high-risk patient populations (Section 6086).
- Prescription Drug Monitoring Programs (“PDMPS”): The CDC is authorized to provide grants to states to improve PDMPs, update PDMP program capabilities, promote community health interventions, and for the evaluation and development of interventions that prevent controlled substance overdoses. This will improve information sharing between states and support research activities related to combating the opioid crisis. The National All Schedules Prescription Electronic Reporting act (NASPER) is also rewritten to guide the use of grant funds for the improvement of state drug monitoring.
- Research: Various provisions provide for increased funding and expand the scope of opioid-related research. Section 7041 allows the National Institute of Health to use its “other transactions authority” to focus on the opioid crisis and on finding non-addictive alternatives for pain management. The bill also expands the scope of the Interagency Pain Research Coordinating Committee to identify risk factors for substance use disorders (“SUD”) and summarize advances in pain care research, including the use of nonpharmacologic treatments and non-addictive medical products (Section 7042).