On February 6, 2018 the House Ways and Means Health Subcommittee held a hearing on prevention and treatment methods for opioid abuse and dependence in Medicare. A panel of senior executives from commercial health plans that serve Medicare beneficiaries, medical professionals, and the Governor of the state of Vermont made up the hearing advisory. Previously, in January, the Oversight subcommittee held a hearing on opioid epidemic focused on the tools in place to collect and utilize data from the Centers of Medicare and Medicaid Services (CMS) in order to take appropriate action to prevent opioid abuse.

The hearing began with opening statement from Chairman Peter Roskam (R-IL) in a bipartisan call to find and implement solutions. He emphasized that all Congressmen have constituents who are affected by the opioid epidemic and the urgency in determining best measures through the panelists’ successful programs. The subcommittee first heard from Governor Phil Scott (R-VT) and Vermont’s Agency of Human Services Secretary, Al Gobeille, on the progress that Vermont’s health care system has made in addressing the opioid crisis. Governor Scott highlighted in his testimony how they have addressed the epidemic in the four areas of prevention, recovery, treatment, and law enforcement. Vermont has one of the most successful “Hub & Spoke” models in the nation that capitalizes on medication-assisted treatment (MAT) as the gold standard for treating opioid addiction and misuse. Governor Scott and his Opioid Coordination Council have worked with CMS and the Health Resources and Services Administration (HRSA) to create programs and comprehensive services that treat opioid addiction similar to any other chronic condition. Congressman Kenny Marchant (R-TX) and Chairman Roskam asked about how Vermont’s healthcare system identifies opioid addicts, to which Gobeille responded highlighting the significant role counseling services play in the Hubs in identifying and helping individuals understand their treatment options. He stated the need for payers to go further than screening tools to identify addicts and to treat the whole patient.

When Congressman Diane Black (R-TN) pointed to the significance of doctor and pharmacy shopping, Governor Scott stated that the implementation of Spokes and their communication with other community providers has improved their Prescription Monitoring System and reduced doctor shopping. However, the Governor adamantly highlighted that while reduction of opioid prescriptions is important, having the capacity to treat and aid recovery is more vital in addressing the opioid epidemic and preventing addicts from turning to more dangerous drugs like heroin and fentanyl. Congressman Adrian Smith (R-NE) questioned the replicability of the Vermont’ system under the Medicare program, to which the Governor and the secretary reiterated the importance of Medicare participating in opioid counseling, treatment, and recovery, as it does for other chronic illnesses. The duo suggested that CMS work with Vermont and engage Medicare in Vermont’s Hub & Spoke care system. Governor Scott also asked for federal investment in research in alternative treatment areas for pain and for coverage options for alternative drugs to opioids.

The subcommittee heard from the other panelists about successful public-private partnerships in the Medicare program during the second half of the hearing. Each health professional went over strategies that have proven successful in their programs’ efforts to address the opioid abuse and misuse and made recommendations accordingly.  First, Dr. Ramsin Benyamin, a member of the Board of Directors of the American Society of Interventional Pain Physicians, proposed an aggressive public education campaign, mandatory education for all prescribers of any amount of opioids, and better access to nonopioid treatments by lowering copay costs. He stated that overdose deaths were mainly due to illicit heroin and fentanyl use in combination with prescription opioids.

Next, the President of BayMark Health Services, doctor Jason Kletter, requested that Congress pass legislation to provide coverage for MAT for Medicare beneficiaries utilizing all FDA-approved medications for opioid use disorder in opioid treatment programs. Kletter suggested that Congress can implement a bundled payment design similar to Medicaid and TRICARE in providing coverage for MAT services.

Third, Executive Vice President and Chief Medical Officer of Aetna Health Insurance, Dr. Harold Paz, suggested that Congress and CMS make changes to limit initial opioid prescriptions to a 7-day supply, ensure the success of Medicare Part D lock-in program, and modernize privacy regulations. Dr. Paz recommended that Congress pass the bipartisan legislation of Representative Jim Renacci (R-OH) and Earl Blumenauer (D-OR), H.R. 3545, to provide providers and organizations access to a patient’s entire medical record. Lastly, Chief Pharmacy Officer of Wellcare Health Plans, Laura Hungiville, stressed that Congress mandate electronic prescribing of opioids to reduce fraud and echoed creation of an education campaign for consumers.

Following the discussion, Chairman Roskam reiterated the importance of Congress to address these issues and promised continued discussion to find the best applicable solutions to the opioid epidemic.  CMS had included some of these recommendations in the draft Call Letter that was released earlier this month. However, per recommendations of the hearing advisory, Congress needs to pass legislation to promote opioid addiction treatment and recovery for Medicare beneficiaries.

Thanks to Simay Okyay for reporting on this hearing.