Advocacy
Opioids Legislation Moving Quickly in the House
The Pain Care Coalition (PCC) reported that the U.S. House of Representatives is expected to begin taking up opioid bills on the House floor sometime in mid-June. No announcement yet as to which bills or in which order, but the intention appears to be to drag this out over a couple of weeks so as to give plenty of members floor time to talk about their own bill or bills.
Rather than commenting on every measure, the PCC (APS is one of three members) wrote to the House leadership to express support for some of the bills under consideration.
In particular, the coalition wrote that it strongly supports H.R. 5002, the Ace Research Act, which provides funding increases for pain and addiction research at NIH and also gives NIH Director Francis Collins more flexibility to speed research in the basic science of pain as well as the development of nonaddictive pain medications and other nonopioid pain management therapies. “The historical underinvestment in pain research is, at least in part, responsible for the over-reliance on opioid medications, and Congress now has the opportunity to correct that unfortunate policy failure. A robust pain research program at the NIH, the Veteran’s Administration, and elsewhere in the government should be a core element in the government’s long-term search for the most effective patient-centered and evidence-based pain care,” wrote the coalition.
The PCC also warned that it would be a mistake to focus physician and other professional education resources only on opioid prescribing. “The long-term goal should be developing a healthcare workforce that is properly educated in the diagnosis and treatment of both acute and chronic pain using a multimodal approach appropriate for individual patients.” The coalition supports the Senate HELP Committee’s action to reauthorize section 759 of the Public Health Service Act to authorize a training grant program. Despite broad bipartisan support, the legislation never was funded.
Senate Staying Busy with Opioids Bills, too
The Senate Finance Committee is considering 22 opioid-related bills. Some focus only on back-end abuse treatment matters, others are largely innocuous “study and report” measures, and a third category includes proposals identical to those from other committees:
S. 2460 requires mandatory e-prescribing for controlled substances under the Medicare Part C Medicare Advantage (“MA”) plans and Part D drug plans. This is essentially the same bill as HR 3528, the Clark bill in the House, which has been cleared by the Energy and Commerce Committee and likely is headed to the House floor soon.
S. 2905 requires (among other things) MA and Part D plans to report to Centers for Medicare & Medicaid Services (CMS) “corrective” actions taken against physicians identified as having inappropriate or ”high-volume” prescribing practices.
S. 2908 requires CMS to establish an electronic prior authorization protocol for MA and Part D plans for all covered drugs, not just controlled substances.
S. 2920 requires CMS to identify “outlier” prescribers, notify them of that identification, and provide them with benchmarking data, and CDC and other guidelines on “proper” prescribing practices. CMS would establish thresholds by specialty and geography for determining who would be considered an outlier.
S. 2911 requires CMS to give guidance to state Medicaid programs on coverage of nonopioid pain management options.
S. 2707 requires CMS to add to the Medicare beneficiary handbook information on opioids and nonopioid pain management options. This bill is similar to HR 5685 on the House side, which has been reported out of the House Energy and Commerce Committee.
S. 2900 requires the “Welcome to Medicare” physical and annual “wellness” visit to include a review of any current opioid prescriptions and screening, where appropriate, for substance abuse disorders.
HHS Pain Management Best Practices Inter-Agency Task Force Meets
The U.S. Department of Health and Human Services (HHS) Pain Management Best Practices Inter-Agency Task Force (Pain Task Force) inaugural meeting occurred on May 30. HHS Secretary Alex Azar made the most compelling remarks, requesting that the Task Force help the United States “properly treat pain.”
Azar pointed out that opioids are no more effective than other multimodal treatments, and that overprescribing of opioids has led to the worst drug crisis in U.S. history. Comparing the United States and Europe, Azar claimed that the United States prescribes four times as many opioids than the European Union. He also referenced the incorporation of pain scores into all aspects of care—including his own recent stint at a hospital—as evidence of pain being a pervasive symptom that the U.S. medical community needs to address effectively. Secretary Azar asked the Task Force to assist in “advancing the practice of pain management,” the fifth pillar of the HHS’s five-pillared strategy to combat the opioid crisis.
Admiral Brett Giroir, assistant secretary for health and senior advisor for opioids and mental health at HHS, spoke about the importance of pain treatment for millions of Americans suffering from pain. He said that the Task Force has an opportunity to participate in a transformational, watershed moment in pain care. He also spoke of the Task Force’s role in identifying and reviewing inconsistencies in pain management and highlighting best practices. He concluded by welcoming feedback from the public regarding the Task Force’s work.
Vanila Singh, MD MACM—chief medical officer for the Office of the Assistant Secretary for Health at HHS—spoke briefly about the charge and scope of the Task Force’s work, indicating that the Task Force has until 2019 to complete its work, including making a report with recommendations.