By: Krista Maschinot, Esq.

It is no secret that this country has an opioid epidemic that has a rising death toll and price tag attached to it. According to the Center for Disease Control, there were approximately 63,632 deaths resulting from drug overdoses in 2016 with 40% of those deaths involving prescription opioids.¹  A study conducted by Altarum, a health care research non-profit, found that the opioid epidemic, for years 2001-2017, cost this country $1 trillion.²  The total cost includes not just lost tax revenue and spending on health care, but also of lost wages, lost productivity, and social service costs.³

President Trump, earlier this week, signed into law H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the SUPPORT for Patients and Communities Act), legislation that the president states will put an “extremely big dent in this terrible, terrible problem.”  This bi-partisan legislation passed the Senate by a vote of 98-1 and the House by a vote of 396-14.  The hope is that this legislation will reduce the estimated 1,000 people treated in emergency rooms each day for opioid misuse and reduce the number of overdose deaths each year.   Highlights include:

• Prohibiting the termination of Medicaid eligibility of juvenile inmates;
• Requiring the establishment of drug management programs for at-risk Medicaid beneficiaries;
• Requiring Medicaid to monitor concurrent prescribing of opioids and antipsychotic drugs for children along with having safety edits in place for opioid refills;
• Requiring an opioid-use disorder screening for new Medicare enrollees;
• Requiring controlled substances covered under Medicare to be transmitted through electronic prescription programs;
• Requiring Medicare to cover certified opioid-treatment programs;
• Incentivizing the use of post-surgical injections instead of opioids through increases to reimbursements at Ambulatory Service Centers.

A summary of the SUPPORT for Patients and Communities Act can be found at https://www.congress.gov/bill/115th-congress/house-bill/6.

Critics of the legislation claim it does go far enough to help the rising problem as it does not provide enough funding for addiction treatment.  

Have you considered ways in which your health plan can help combat this problem?  Perhaps by offering non-drug treatments for pain such as acupuncture, physical therapy, yoga therapy, or psychological interventions?   Reach out to our consulting team at pgcreferral@phiagroup.com for assistance.