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October 4, 2018

The 660-page bill to combat the US opioid epidemic heads to Trump

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    Congress has sent a bipartisan, bicameral legislative package (HR 6) to address the opioid epidemic to President Trump.

    New tool: Access the Medicare Opioid Prescription Assessment

    The House last week voted 393-8 to pass the measure, and the Senate on Wednesday voted 98-1 to approve the legislation. Trump is expected to sign the measure.

    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 epidemic through a variety of public health initiatives to expand access to treatments for opioid use disorders, 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 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.

    The legislation also would partially repeal a decades-old rule known as the Institutions for Mental Diseases (IMD) exclusion rule, which bars Medicaid from covering inpatient care at a substance use disorder treatment facility with more than 16 beds. The legislation would allow Medicaid to cover 30 days of inpatient substance use disorder treatment in large facilities for individuals between ages 21 and 65 who have had any substance use disorder for at least one year.

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

    The bill also includes provisions 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; and
    • Require Medicaid managed care organizations to spend at least 85% of federal funding on care, as opposed to administrative costs.

    The Congressional Budget Office has projected that the legislative package ultimately would save the federal government $2 million over ten years, Modern Healthcare reports.

    Lawmakers tout the package, but say there's more work to be done

    Sen. Lamar Alexander (R-Tenn.) said, "We're not pretending a single act here can fix the problem [but] we want to do everything we can do to provide tools for parents and patients and doctors and nurses and governors and anyone we can find to deal with this crisis." Alexander noted, "Including the appropriations bill passed in March and [a] bill approved last week, [Congress will] have directed $8.5 billion toward the opioid crisis."

    Sen. Edward Markey (D-Mass.) said, "The final opioid package represents a critical component. But this should not and will not be the end of Congress's efforts." Markey said there continue to be a few "outstanding issues" that Congress needs to address, such as the need for "mandating provider education and labeling opioid bottles on the risk" of misuse.

    Industry groups react

    A number of public health experts, advocates, and groups have indicated they largely support the measure, but some have raised concerns over what was not included in the legislative package.

    The American Society of Addiction Medicine, the National Community Pharmacists Association, and the American Psychiatric Association (APA) all praised the bill's passage. However, APA President Altha Stewart said APA is "disappointed … the final bill did not include critical reforms to ... improve care coordination and patient safety for the treatment of substance use disorders while preserving patient privacy." Stewart added, "We urge the Senate to hold a separate vote on [that legislation] to ensure that these enhanced patient safety, care coordination, and consumer protections become law."

    Lindsey Vuolo, associate director of health law and policy at the Center on Addiction, said, "This legislation edges us closer to treating addiction as the devastating disease it is, but it neglects to provide the long-term investment we've seen in responses to other major public health crises." Vuolo said, "We won't be able to make meaningful progress against the tide of addiction unless we make significant changes to incorporate addiction treatment into the existing health care system" (Itkowitz, "PowerPost," Washington Post, 10/3; Lopez, Vox, 10/3; Sullivan, The Hill, 9/28; Luthi, Modern Healthcare, 9/28; Sullivan, The Hill, 10/3; Frieden, MedPage Today, 10/3).

    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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