This story originally appeared on Inside Health Policy.
President Obama surged forward with a comprehensive plan to end the rampant opioid crisis that includes putting mental health and substance benefits in Medicaid on par with other benefits and increasing access to medication-assisted treatment — proposals that top off his request for $1.1 billion in new funding in fiscal 2017 to address the issue.
CMS finalized a rule on Tuesday making mental health and substance abuse benefits comparable to medical and surgical ones in Medicaid and the Children’s Health Insurance Program (CHIP). Obama also announced a mental health and substance-use disorder parity task force as a part of his comprehensive approach to resolve the opioid crisis. He touted his package of solutions at a National RX Drug Abuse and Heroin Summit on Tuesday (March 29) in Atlanta.
CMS also proposed a rule on Tuesday to increase the current patient limit for qualified physicians who prescribe buprenorphine — a drug that treats opioid disorders — from 100 to 200 patients.
But Behshad Sheldon, president of Braeburn Pharmaceuticals, doesn’t think the proposal goes far enough. She said raising the cap is good but with the restrictions tacked on the plan will have little to no impact on improving access to treatment.
Sen. Chuck Grassley (R-IA) is happy about the cap, but said it took the administration too long to impose this type of policy.
House Energy & Commerce ranking Democrat Frank Pallone (NJ) praised Obama’s package, however, specifically noting the proposal to increase access to buprenorphine. He also urged Congress to pass Obama’s $1.1 billion request to help overcome the substance-abuse crisis.
President Obama also said the culture of over prescribing and excess needs to end. He said the medical and pharmaceutical industries and consumers need to be held more accountable for this excess. Michael Barnes, executive director of the Center for Lawful Access and Abuse Deterrence, praised Obama for also holding the insurance industry accountable for complying with the law and paying for addiction treatment.
At Tuesday’s Summit, Patrice Harris, chair-elect for the American Medical Association, urged physicians to reduce the stigma of substance-use disorders and increase access to treatment.
“[O]ur vision will only be complete when we not only are implementing proven solutions for treatment, but also when America’s flawed perceptions about pain and substance abuse come to an end. We still have a long way to go on stigma — and that is where everyone here can play a role, and you have our commitment to join you in this critical effort,” Harris said.
The president’s announcement comes as CMS pushes for more access to medication-assisted treatment. Earlier this month the agency allocated $94 million in new funding to 271 community health centers across the country to increase substance-use disorder treatment services, focusing on expanding medication-assisted treatment of opioid-use disorders in underserved communities.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is designating $11 million funding to up to 11 states to expand their medication-assisted treatment services as another part of the administration’s proposals. SAMHSA will also train doctors to increase the number of doctors qualified to prescribe buprenorphine.
Harris said she is concerned about barriers to medication-assisted treatment, such as prior authorization, step therapy and fail first protocols.
“We need to work together to ensure that policies support optimal treatment — and like the approach to pain management, we need to change the national discussion. We need to work together to advocate for policies such as lifting the cap on treating patients in our offices with buprenorphine,” Harris said.
The administration is also pushing for more training and distribution of naloxone–the opioid overdose reversal drug.
SAMHSA is allocating a separate $11 million to states to buy and distribute naloxone and to train first responders and others on how to use it and other strategies. The administration is expanding and investing in law enforcement to help counter substance use disorders, particularly in community policing. Obama also said 100 million dollars is allocated to community health centers.
Sen. Shelley Capito (R-WV) said she supports the co-prescribing of naloxone and investing in community health centers that the administration announced Tuesday and has been fighting for these measures herself.
In the private sector, more than 60 medical schools announced that, beginning in fall 2016, they will require their students to take some form of prescriber education. Additionally, CVS and Walgreens have both increased access to naloxone.
CMS also recently released guidance to states about how to address the prescription opioid overdoses, misuse and addiction in Medicaid. Patient Review and Restriction Programs are included in this guidance.
Patient Review and Restriction programs (PRRs) are used for insurers to assign patients who are at risk for drug abuse to predesignated pharmacies and prescribers to receive these drugs. Public and private insurers are using PRR programs to promote safe opioid use, according to a recent Pew Charitable Trusts report on PRRs.
Harris said the AMA task force on opioid abuse urges all physicians to use their state’s prescription drug monitoring programs (PDMPs) to prescribe better and identify individuals who may have a substance use disorder.
CMS is also proposing new guidance on use of federal funds to enforce or expand syringe services programs for people who inject drugs. The FDA recently announced safety labeling changes for all immediate-release opioid pain medications, including requiring a new boxed warning about the risks of these drugs. The Centers for Disease Control and Prevention also recently released guidance on prescribing opioids for chronic pain.
Barnes said Obama had a tone of urgency at the Summit.
“Today we are seeing more people killed because of opioid overdoses than traffic accidents,” Obama said. — Erin Raftery (firstname.lastname@example.org)