Medicare reimbursement caught in the crosshairs of congressional opioid talks

Hydrocodone opioid pills
Lawmakers on an influential House committee appear to be looking at Medicare reimbursement as a main culprit of opioid overprescribing. (Getty/smartstock)

As numerous committees in Congress attempt to tackle the opioid crisis, one, in particular, seems to be eyeing Medicare reimbursements as a likely culprit of overprescribing, but regulation changes could provide a remedy.  

Leaders of the influential House Ways and Means Committee released a white paper (PDF) on Wednesday outlining feedback from payers, providers and pharmacists about the best approaches to combating the opioid epidemic, and many ideas sound familiar.

Respondents laid some blame on Medicare's current reimbursement structure as a driver of opioid overprescribing, and said that physicians are "inadequately compensated for their time screening patients for opioid use disorders, checking state drug monitoring registries, and working with patients to manage their pain."

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

A chief recommendation from respondents included increasing reimbursements for medication-assisted treatments, which combine medication with counseling for people with addiction. The service is currently only covered under Medicare in an inpatient setting, creating gaps for many patients. 

Another heavily supported recommendation was more comprehensive reimbursement policies for nonopioid treatment options like physical therapy and acupuncture that can be "just as effective as opioids in treating chronic pain, if not more so," the lawmakers wrote. Many of these treatments are not currently covered by Medicare for certain conditions, which leaves opioids as the main alternative for many patients. 

RELATED: CMS finalizes regulations to curb opioid misuse among Part D beneficiaries

A small portion of respondents, about 10%, suggested changes to Medicare Part D's lock-in program, which is designed to protect patients from accessing too many similar drugs at once. 

Opioid use in the Medicare programs continues to be a problem. According to HHS, one-third of Part D patients were prescribed at least one opioid in 2016, at a cost of about $4.1 billion.

Meanwhile, the Trump administration has taken steps recently to try to curve opioid use under Medicare Part D. In a rule released last week, the Medicare agency set a cap on all new opioid prescriptions for short-term acute pain at a seven-day supply starting next year. 

The rule also established a ceiling of 90-milligram morphine-equivalent units for opioid prescriptions under Part D. A prescription at or above 90 mg will require the pharmacist to speak with the prescribing doctor regarding the dosage and determine if an override is appropriate.