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September 26, 2018

Inside the 660-page bill to combat the US opioid epidemic

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    After weeks of negotiations, House and Senate negotiators on Tuesday unveiled a wide-ranging joint legislative package (HR 6) to address the opioid misuse epidemic.

    New tool: Access the Medicare Opioid Prescription Assessment

    According to CQ News, House aides said House leaders hope to pass the bill as soon as Thursday, with the Senate taking up the bill shortly thereafter in hopes of sending it to President Trump's desk by the end of the week.

    Legislative package details

    The 660-page legislative package, which has been assembled over several months by eight House committees and five Senate committees, seeks to address the opioid misuse epidemic through a variety of public health initiatives to expand access to opioid misuse treatments, promote the development of alternative treatments for pain, and prevent the entry of illicit drugs into the United States.

    The package includes measures that would:

    • Authorize FDA to require drug manufacturers to provide special safety packaging for opioids, such as sealing them in plastic blister packs and restricting packages to three to seven days' worth of medication;
    • Crack down on mailed shipments of illicit drugs such as fentanyl;
    • Expand a program that authorizes first responders to administer the opioid overdose reversal drug naloxone;
    • Grant the NIH additional authority to research and develop non-opioid pain treatments;
    • Offer loan repayments to behavioral health providers practicing in substance use disorder facilities in locations where there is a shortage of mental health professionals;
    • Overhaul prescription drug monitoring programs; and
    • Reauthorize the Office of National Drug Control Policy.

    Negotiators this past week dug in on lingering differences between the House-passed package and the Senate-passed bill.  

    For example, lawmakers reached an agreement on a provision to partially repeal a decades-old rule known as the Institutions for Mental Diseases (IMD) exclusion rule, which bars Medicaid from covering inpatient care a substance misuse facility with more than 16 beds.

    The final deal would allow Medicaid to cover 30 days of inpatient substance misuse treatment in large facilities for individuals between ages 21 and 65 who have had any substance use disorder for at least one year. The House-passed version had limited the coverage to just opioid misuse and cocaine use, while Sen. Rob Portman (R-Ohio) had pushed for up to 90 days of Medicaid coverage.

    Hospitals and inpatient facilities have pushed for the change, but others in the health care industry have argued the move will take funds away from community-based treatment and give those funds to higher cost resident treatments.

    Lawmakers did not reach a deal on a Senate-passed provision to lift privacy restrictions for medical records for individuals with past substance misuse treatment. The provision has been one of the more contentious, as supporters argue it would improve care coordination while opponents say it could lead to discrimination and discourage individuals with substance use disorders from seeking treatment.

    Two other provisions that the Washington Post's "PowerPost" reports slowed negotiations this week also did not make the cut:

    • A provision backed by the Pharmaceutical Research and Manufacturers of America that would lower drugmakers' financial liability for seniors in Medicare's "doughnut hole" coverage gap to 63%, down from the 70% threshold set to take effect next year; and  
    • A version of the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act, which would create incentivizes for the production of biosimilars and generics.

    The final bill did, however, include two House-passed offsets, CQ News reports:

    • One requiring Medicaid managed care organizations to spend at least 85% of federal funding on care, as opposed to administrative costs; and
    • Another that would extend prescription drug coverage reporting requirements under Medicare Part D to ensure HHS and Medicare sponsors know when supplementary insurance should be billed before Medicare.  

    Experts say more funding is needed

    Public health experts and health advocates largely support the bill, but some have voiced concerns that it does not allocate enough new funding to make a big impact, "PowerPost" reports.

    Keith Humphreys, a drug policy expert at Stanford University who worked with Senate and House staff on their bills, said that "there are many 'small sanities' in the Senate and House opioid bills that will make a positive difference" (Itkowitz, "PowerPost," Washington Post, 9/26; Baker, Axios, 9/26;  Sullivan, The Hill, 9/25; Raman, CQ News, 9/25 [subscription required]; Luthi, Modern Healthcare, 9/24; Baker, "Vitals," Axios, 9/25; Diamond, "Pulse," Politico, 9/25; Pear, New York Times, 9/24; Florko/Facher, STAT News, 9/24; Facher, STAT News, 9/21).

    Your top resources for combatting the opioid epidemic—in one place

    The opioid epidemic is a complex, multi-dimensional public health problem. Use this list of helpful resources on how hospitals and health systems can play a role to treat opioid addiction and prevent further increase in opioid abuse.

    Access our Opioid Resources Here

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