House Ways and Means Committee calls on CMS to strengthen opioid epidemic response in Part D program

Lawmakers are looking for CMS to offer more information on how it is combating opioid abuse in the Medicare program, and they offered solutions that could bolster the agency's efforts to curb the crisis.

The bipartisan group of four representatives from the House Ways and Means Committee noted in a letter (PDF) that a report from the Department of Health and Human Services Office of Inspector General revealed one-third of Medicare Part D beneficiaries filled an opioid prescription in 2016. 

Nearly 90,000 Part D enrollees were prescribed "extreme" amounts of opioids in 2016, the legislators noted in the letter, which was addressed to Centers for Medicare & Medicaid Services Administrator Seema Verma.  

The legislators—Rep. Kevin Brady, R-Texas; Rep. Richard Neal, D-Mass.; Rep. Peter Roskam, R-Ill.; and Rep. Sandy Levin, D-Mich.—also requested additional details on the thinking behind CMS' proposed "four pharmacies" test for potential abuse, which would track four pharmacies to determine which beneficiaries are at-risk, and how the agency settled on waiting six months to restrict prescriptions after a beneficiary is determined to be at risk-for abuse. 

RELATED: CMS reveals new Medicaid policy aimed at the opioid crisis 

The representatives offered suggestions for steps the agency could take in its efforts, based on multiple hearings on opioids within the committee, including: 

  1. Assess how Part D plan sponsors are responding to the epidemic: CMS works with Part D plan sponsors to monitor billing patterns for potential abuse, but both the OIG and the Government Accountability Office have said this is a point of weakness in the program. CMS can increase transparency and improve reporting, according to the letter. 
  2. Push sponsors to restrict beneficiaries to a certain number of pharmacies or prescribers: By offering a limited slate of pharmacies or providers for coverage, CMS and Part D sponsors can identify beneficiaries at risk for opioid misuse more quickly.
  3. Include pharmacists in case management: Pharmacists can provide a crucial frontline intervention that Part D plans could take advantage of to avoid overprescribing, the letter suggested. 
  4. Expand overuse monitoring capabilities to include other drugs: CMS and its partners should better monitor beneficiaries' use of drugs that are seen as opioid "potentiators" and increase risk for future abuse. 

The letter requests a response from CMS by March 23, "given the severity of the crisis and that fact that both OIG and GAO have examined and reported gaps in CMS' system of monitoring opioid-related abuse." 

RELATED: Anthem plans to reduce filled opioid prescriptions by 30% 

"The lives of thousands of Americans are at risk—and we can only develop sustainable solutions if we work together," the representatives wrote. 

CMS has taken steps over the past several months to address the opioid crisis, including unveiling a new Medicaid program that would allow states to design projects within Medicaid to increase access to substance abuse treatment. Experts have said that Medicaid should be the front line for policymakers looking to curb opioid abuse. 

CMS has also proposed a seven-day limit on opioid prescriptions, a policy that would take effect in 2019 and is likely to meet resistance from physicians.