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Field Hearing in Bucks County Focuses on Opioid Overutlization in Medicare and Medicaid

May 30, 2018

A field hearing convened by U.S. Senator Pat Toomey, in his capacity as Chairman of the U.S. Senate Finance Subcommittee on Health Care, provided a forum to explore trends in the utilization of opioids, and federal efforts to reduce opioid overutilization and misuse within the Medicare and Medicaid programs.

The hearing—Examining Efforts to Prevent Opioid Overutilization and Misuse in Medicare and Medicaid—featured testimony from government officials exercising oversight over Medicare and Medicaid, and presented the perspectives of patients, law enforcement, and the health care sector. Specifically, witnesses included:

Senator Toomey and witnesses highlighted some concerning statistics and trends:

  • Although opioid volume has declined nationwide since 2011, per person opioid usage still remains five times higher than it was three decades ago
  • Medicare is the single largest purchaser of prescription opioids, and one out of every three Medicare Part D beneficiaries received an opioid prescription in 2016
  • A recent study from the University of Pittsburgh School of Public Health found that Pennsylvania Medicaid beneficiaries who suffered a nonfatal overdose received another legal prescription within the next six months 60 percent of the time

The hearing supports ongoing work by the Senate Finance Committee to advance opioid legislation. Last week, the Committee introduced 22 bipartisan bills addressing policy within the Medicare, Medicaid, and human services programs. Leadership of the Committee has pledged to convene a mark-up to consider the proposals in the coming weeks and may be releasing additional bills.

Senator Toomey specifically highlighted a series of policy avenues he is pursuing including:

  • Encouraging appropriate prescribing for victims of overdose by modifying current drug utilization management tools within the Medicare and Medicaid programs to protect at-risk beneficiaries
  • Strengthening Partnerships to Prevent Opioid Abuse Act (S. 2905) which would create an online portal through which prescription drug plan sponsors would be required to report opioid overprescribing and refer substantiated cases of fraud and abuse to the Centers for Medicare & Medicaid Services (CMS)
  • Every Prescription Conveyed Securely Act (S. 2460) which would mandate electronic prescribing for controlled substances in the Medicare Part D program
  • Commit to Opioid Medical Prescriber Accountability and Safety for Seniors Act (S. 2920) which would require CMS, in consultation with stakeholders, to establish a threshold, based on specialty and geographic area, for which a prescriber would be considered an outlier opioid prescriber

It is expected the U.S. House will vote on opioid legislation the week of June 11. The U.S. Senate is also working to complete their Committee process in the coming weeks. Leadership of both Chambers is eager to enact a final policy package before the end of the summer.

The U.S. House Energy & Commerce Committee initially advanced 25 bills and then considered another 32 pieces of legislation, and the U.S. House Ways & Means Committee also approved 7 bipartisan bills. In late April, the U.S. Senate Health, Education, Labor and Pensions Committee unanimously approved a comprehensive package that incorporated 40 policy provisions championed by 38 different Senators.

For information about HAP’s clinical work around the opioid crisis, contact Michael Consuelos, MD, HAP’s senior vice president, clinical integration. For information about federal efforts, contact Laura Stevens Kent, HAP’s vice president, federal advocacy.

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