Alliance for Patient Access / IfPA’s Patient Access Policy Blog / What Medicare’s Opioid Policy Left Out

What Medicare’s Opioid Policy Left Out

More than 1,000 people per day receive treatment in emergency rooms across the country for misusing prescription opioids. And approximately 115 Americans die daily from opioid overdose.

Statistics like these have spurred calls for action, and federal policymakers are taking note.

In particular, the Centers for Medicare and Medicaid Services recently proposed new strategies to address opioid overuse in Medicare Part D. Among other changes, CMS’ proposal includes dispensing limits and safety edits, which allow pharmacists to verify before dispensing additional medicine that a particular patient won’t be exceeding the maximum daily dose.

Given that one in three Part D beneficiaries received at least one prescription opioid in 2016, a shift in CMS’ approach could have wide-ranging effects. But while these strategies may curb excessive distribution of prescription opioids, CMS has an opportunity to do more. Specifically, the agency should consider how to deter not just opioids’ overabundance but also their misuse.

Including FDA-approved abuse-deterrent opioids is one way to do that.

A group of stakeholders, including the Abuse Deterrent Coalition and the Alliance for Patient Access, signed a letter to CMS reiterating the importance of making abuse-deterrent formulations accessible, calling CMS’ proposed approach without them a “missed opportunity.”

The authors urge CMS to “consider and encourage the preferential utilization of abuse-deterrent opioids” in its opioid policy.

Abuse-deterrent opioids don’t reduce the risk of addiction, but they can deter misuse of the drugs by making pills harder to crush or dissolve. Despite the availability of abuse-deterrent opioids, however, their utilization remains low. Lack of awareness by doctors who are treating patients in pain may be one reason. Price is another; abuse-deterrent opioids are not yet available in generic form.

And the high price tag prompts health plans, both public and private, to implement utilization management barriers like prior authorization and step therapy. These techniques make it more difficult for patients to access the abuse-deterrent version of their medication, limiting the drugs’ ability to provide valuable public health benefits.

Rather than restricting abuse-deterrent opioids, officials should ensure their availability—recognizing that they are a critical component of drug abuse prevention efforts. As FDA Commissioner Scott Gottlieb explained, “Transitioning from the current market, dominated by conventional opioids, to one in which opioids have abuse-deterrent properties, holds significant promise for a meaningful public health benefit.”

By adding abuse-deterrent technology to its proposed strategies, CMS can provide a Part D policy that better serves both its beneficiaries and the nation’s ongoing public health emergency.

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