HHS opioid actions would raise buprenorphine cap, delink payment from pain survey

Physicians will be able to prescribe a medication to combat opioid addiction to more patients as part of several new policies HHS has announced in an effort to fight the rise in misuse and deaths tied to opioids obtained both illegally and with a prescription.

The medication, buprenorphine, has proven to be one of the most effective methods in combating opioid dependence, but has been subject to strict prescription limits to prevent the drug from getting into the hands of illicit drug dealers of heroin and other opioids. The final rule from HHS would allow physicians to prescribe buprenorphine to 275 patients, a large increase from the previous cap of 100.

“The opioid epidemic is one of the most pressing public health issues in the United States. More Americans now die from drug overdoses than car crashes, and these overdoses have hit families from every walk of life and across our entire nation,” HHS Secretary Sylvia Burwell said in a statement. “At HHS, we are helping to lead the nationwide effort to address the opioid epidemic by taking a targeted approach focused on prevention, treatment, and intervention.”

Physicians will still need a waiver to prescribe buprenorphine, which can be obtained if they have addiction medicine or addiction psychiatry credentialing from a specialty medical board and/or professional society, or practice in a qualified setting.

The HHS action follows other agency endorsements of the medication, such as the Food and Drug Administration’s approval of an implanted buprenorphine device in May.

One of the proposed changes include in the HHS announcement would deal with Medicare policies which physicians have claimed encourages overprescription.

To fight “even the perception” of financial pressure to give patients opioids, CMS would remove patient surveys on pain management from the scoring calculation for hospital payments.

“This means that hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive,” HHS said.

The American Medical Association passed a resolution asking for this very change at its annual meeting in June.

The other proposals announced by HHS include requiring Indian Health Service providers and pharmacists to check prescription drug monitoring databases in their states, launching a dozen new studies on opioid abuse and pain management treatments, and requesting comments on how to improve prescriber training programs.

Along with these actions, Burwell also called for Congress to match President Barack Obama’s $1.1 billion budget request for anti-opioid addiction programs.

“We need our partners in Congress to do their part and fund the president’s budget request,” she said. “In the absence of congressional action we’re taking every step forward we can.”

It doesn’t appear Burwell will get her wish. In the latest bill drafted by Republicans, only $85 million in new funding for opioid addiction programs would be appropriated over five years, according to the Congressional Budget Office.  At a meeting of the congressional conference committee on the opioid bill Wednesday, Democrats proposed amendments which would’ve added $920 million in new spending, but those proposals were unanimously rejected by Republicans.