Barriers to opioid treatment persist, CDC study says

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Jul 26, 2023 View in browser   By Ben Leonard and Daniel Payne Presented by With help from Robert King, Erin Schumaker and Evan Peng Driving The Day Despite the government's steps to make it easier for doctors to prescribe buprenorphine, barriers to opioid treatment remain. | Elise Amendola/AP Photo THE X FACTOR — Despite Congress’ lifting of the so-called X-waiver in a bid to make it easier for providers to prescribe buprenorphine to treat opioid use disorder, a new survey of more than 2,700 clinicians suggests myriad barriers remain. The analysis from researchers at the CDC, HHS and the Substance Abuse and Mental Health Services Administration explored how developing new practice guidelines — aimed at reducing educational burdens — to be able to prescribe the drug impacted prescribing habits. Congress later went further in the most recent omnibus spending package in December 2022 by eliminating the waiver required to prescribe. The findings: The researchers found that providers who became eligible under the eased 2021 guidelines were less likely to prescribe the lifesaving drug than providers who did so under the traditional guidelines, which required additional training. They also pointed to recent research showing that while the guidelines increased the number of providers eligible to prescribe, it didn’t lead to an increase in prescribing above historic trends. Those providers eligible to prescribe buprenorphine under the guidelines cited similar barriers to those under the old guidelines, including lack of patient demand, concerns about treating patients with opioid use disorder and insufficient institutional support, lead author Chris Jones of the CDC told Pulse. He argues that in the post-X waiver climate, in line with what happened after the practice guidelines were eased, it will be key to address other barriers, including reimbursement, workforce shortages and stigma. “Removing one barrier … did not diminish these other barriers,” he told Pulse. Why it matters: The researchers say the findings about the 2021 practice guidelines reinforce that removing the X-waiver won’t end other barriers to care, including DEA regulations, awareness, stigma and insurance requirements, among other things, as I previously reported. Nearly 110,000 people in the U.S. died of an overdose between February 2022 and February 2023. Reaction: Treatment advocates agree more needs to be done. Libby Jones, program director at the Overdose Prevention Initiative at the Global Health Advocacy Incubator, called for reauthorization of the SUPPORT Act, which tackles the opioid epidemic, along with added provisions to expand access to care for incarcerated people. Brian Hurley, president of the American Society of Addiction Medicine, called for Congress to boost funding for addiction medicine fellowships and reimbursement for comprehensive treatment. Bobby Mukkamala of the American Medical Association called for more research into the barriers, and Stephen Martin, head of research and education at Boulder Care, a treatment clinic, called for bolstering value-based payment arrangements for treatment. “Nothing is moving fast enough,” Martin said. WELCOME TO WEDNESDAY PULSE. How should the U.S. handle the opioid crisis going forward? Reach me at bleonard@politico.com with ideas, tips and more, and reach our usual host, Daniel, at dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Megan Messerly talks with Ben, who reports on the White House’s push to force health insurers to comply with a 2008 law meant to equalize mental and physical health benefits — and what it would mean for patient access and costs. Listen to today’s Pulse Check podcast   A message from PhRMA: Research and development of cancer medicines after their initial FDA approval can help expand treatment populations, find new ways of treating a cancer or help patients earlier in their cancer battle. Unfortunately, provisions in the Inflation Reduction Act put this progress in jeopardy by selecting medicines for price setting before many of these critical advancements can be fully realized. Read the new report.   In Congress House Ways and Means Committee Chair Jason Smith (c.), ranking member Richard Neal (r.) and other committee members are poised to mark up two health care–related bills today. | Francis Chung/POLITICO W&M EYES PRICE TRANSPARENCY, DRUG COSTS — The House Ways and Means Committee is set to mark up legislation this morning aimed at reducing health care costs and boosting transparency in pricing in the sector. The meatiest of the two bills being marked up would limit cost-sharing in the Medicare program beginning in 2027 by bringing patients’ out-of-pocket drug costs in line with the negotiated price not the cash price. It would also require hospitals, group health plans and pharmacy benefit managers to disclose additional information about their prices. And the legislation would also attempt to rein in insurers’ use of prior authorization in Medicare Advantage. The other bill would require an annual HHS report discussing how Medicare regulations impact consolidation. The bigger picture: The transparency bill comes after other key committees have advanced price transparency legislation, including the House Education and the Workforce and Energy and Commerce committees. It’s unclear which measures could fit into a potential health care package that’s been discussed. CMS also put forward new hospital transparency requirements earlier this month in its proposed physician fee schedule.   A message from PhRMA:   HOUSE ACTS ON FENTANYL, ORGAN TRANSPLANTS — The House passed two health care–related bills by voice vote Tuesday night: the Stop Chinese Fentanyl Act and the Securing the U.S. Organ Procurement and Transplantation Network Act, Erin and Evan report. The fentanyl bill would sanction Chinese chemical manufacturers and officials who fail to combat synthetic opioid trafficking. No members expressed opposition during the debate preceding the vote. However, at the House Foreign Affairs Committee markup of the bill in May, ranking member Gregory Meeks (D-N.Y.) expressed reservations, arguing that it would backfire and discourage Chinese action on fentanyl. A broader fentanyl-related sanctions measure, including Mexican cartel targets, may also make it into the Senate’s defense policy bill expected to be taken up this week. The organ transplant bill aims to make the nation’s beleaguered organ transplant network more competitive. For the past 40 years, the government has contracted with a single organization, the nonprofit United Network for Organ Sharing. But a Senate Finance Committee investigation into UNOS concluded that “the U.S. transplant network is not working, putting Americans’ lives at risk.” The report recommended removing barriers to competition and breaking up the existing contract. The bill authorizes the Health Resources and Services Administration to award contracts to multiple bidders and eliminates the cap on contracts. PACT ACT OVERSIGHT — The Senate Veterans’ Affairs Committee is set to examine the implementation of the PACT Act, the sweeping expansion of health care for veterans exposed to burn pits and substances like Agent Orange. “It’s on VA to implement this law as seamlessly as possible — which is no easy task,” Committee Chair Jon Tester (D-Mont.) plans to say in prepared remarks obtained by Pulse. Ranking member Jerry Moran (R-Kan.) plans to raise several concerns about the implementation of the legislation. That includes the PACT Act claims backlog and whether the VA sufficiently tracks how many veterans enroll in VA health care due to the legislation. DEMS PRESS CMS ON MEDICARE ADVANTAGE — House Democrats want the Biden administration to do more to rein in overpayments and increase the transparency of Medicare Advantage plans, the latest fissure in traditional bipartisan support for the program, Robert reports. Lawmakers spoke during a press conference Tuesday highlighting issues surrounding coverage denials by Medicare Advantage plans. Democrats have become angry in recent months over reports of insurers using algorithms to deny Medicare claims that should have been approved and problems with overpayments. Rep. Lloyd Doggett (D-Texas) wants CMS to take a closer look at how Medicare Advantage plans are marketed to older adults, especially as plan choices have skyrocketed. Doggett said plans aren’t transparent enough about the downsides of Medicare Advantage, which can include narrow doctor networks or cost containment tools that could lead to coverage being denied. “It is really outrageous to be leading people to believe they will be getting free groceries and free rent,” he said. CMS did not immediately return a request for comment.   YOUR TICKET INSIDE THE GOLDEN STATE POLITICAL ARENA: California Playbook delivers the latest intel, buzzy scoops and exclusive coverage from Sacramento and Los Angeles to Silicon Valley and across the state. Don't miss out on the daily must-read for political aficionados and professionals with an outsized interest in California politics, policy and power. Subscribe today.     At the White House RESPONSE TO BIDEN MENTAL HEALTH PLAN — AHIP, the lobbying organization for health insurers, says the lack of access to mental health care is rooted in clinician shortages, not insurer evasion of mental health parity laws, spokesperson Kristine Grow told POLITICO. The insurer’s response comes after the Biden administration accused insurers Tuesday of failing to comply with a 2008 law requiring them to put mental health care on the same footing as physical care and proposed new rules aimed at ensuring insurers pay their share of the costs. “Access to mental health has been, and continues to be, challenging primarily because of a shortage and lack of clinicians, which is why for years, health insurance providers have implemented programs and strategies to expand networks and increase access,” Grow said in a statement, saying AHIP agrees that access should be comparable to that for physical health. President Joe Biden defended the regulations in a speech Tuesday, arguing they will save billions of dollars and slamming insurers for having “badly inadequate” networks. The proposal is arguably the most sweeping action Biden has taken thus far on mental health, especially in the private insurance market. What We're Reading STAT reports on a health data giant’s run-in with the FTC. The New York Times examines the mystery of Covid origins. CNN reports that doctors in Arizona have to treat patients burned by falling because of the heat.   JOIN 7/27 FOR A TALK ON WOMEN LEADERS IN THE NEW WORKPLACE: In the wake of the pandemic, U.S. lawmakers saw a unique opportunity to address the current childcare system, which has become increasingly unaffordable for millions of Americans, but the initial proposals went nowhere. With the launch of the Congressional Bipartisan Affordable Childcare Caucus in May, there may be a path to make childcare more affordable. Join Women Rule on July 27 to dive into this timely topic and more with featured speakers Rep. Nancy Mace (R-S.C.), Rep. Ro Khanna (D-Calif.) and Reshma Saujani, Founder & CEO of Moms First and Founder of Girls Who Code. REGISTER HERE.       A message from PhRMA: A new report showcases the vital role of post-approval R&D in nine critical oncology treatments. This research can help expand treatment populations, find new ways of treating a cancer or help patients earlier in their cancer battle. Unfortunately, provisions in the Inflation Reduction Act put this progress in jeopardy by selecting medicines for price setting before many of these critical advancements can be fully realized. See how post-approval R&D in cancer is at risk.     Follow us on Twitter Dan Goldberg @dancgoldberg Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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