Roskam confronts nation’s opioid crisis via Medicare Advantage Program

Following a May 8 U.S. House Ways and Means Health Subcommittee hearing on the Medicare Advantage Program chaired by U.S. Rep. Peter Roskam (R-IL), the congressman proposed three pieces of related, bipartisan legislation targeting America’s deepening opioid disaster.

“The opioid crisis is whipsawing our culture,” U.S. Rep. Roskam said in a May 14 statement about introducing the series of bills. “It is vital that we come together to solve it and these bipartisan bills move us in the right direction.”

Rep. Roskam on May 9 introduced the Benefit Evaluation of Safe Treatment (BEST) Act, H.R. 5725, which would direct the U.S. Department of Health and Human Services to review and submit to Congress a report on the extent to which Medicare Advantage plans offered under part C of the Medicare program include supplemental health care benefits designed to treat or prevent substance use disorders, according to the congressional record.

Ensuring access to alternative non-opioid treatments is the first step to addressing severe addiction and pain, according to Rep. Roskam’s statement, and H.R. 5725 would help identify how such treatments are covered outside of traditional Medicare coverage, and would urge Medicare Advantage plans to continue exploring coverage for such new alternatives.

Cosponsors of H.R. 5725 include U.S. Reps. John Shimkus (R-IL) and Linda T. Sánchez (D-CA), vice chair of the U.S. House Democratic Caucus.

Also on May 9, Rep. Roskam introduced the Commit to Opioid Medical Prescriber Accountability and Safety for Seniors (COMPASS) Act, H.R. 5716, to establish a process that essentially puts prescribers on notice to evaluate their prescribing practices and to address any erroneous practices, according to a summary provided by the lawmaker’s office.

H.R. 5716 would require the Centers for Medicare and Medicaid Services (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.” CMS then would notify prescribers identified as outliers of their status, essentially as a flag for these prescribers to get their act together.

Cosponsors of H.R. 5716 are U.S. Reps. Susan Brooks (R-IN), John Larson (D-CT), and Peter Welch (D-VT).

On May 3, Rep. Roskam was among the original cosponsors, along with U.S. Reps. Marsha Blackburn (R-TN) and Ben Ray Lujan (D-NM), of H.R. 5675, which would require prescription drug plan sponsors under the Medicare program to establish drug management programs for at-risk beneficiaries. U.S. Rep. Gus Bilirakis (R-FL) introduced H.R. 5675.

Patient review and restriction programs – often called “lock-in” programs – many times get utilized in opioid-crisis situations because they lock in a patient to a single designated provider and/or pharmacy, preventing a patient from doctor shopping and pharmacy hopping, said Rep. Roskam’s staff.

Currently, Medicare Part D plans have authority to run lock-in programs, but under H.R. 5675, Part D plans would be required to create such programs, ensuring both uniformity and identification and assistance for high-risk beneficiaries, the congressman’s staff said.

All three bills have been referred to the U.S. House Ways and Means Committee and the U.S. House Energy and Commerce Committee for consideration.

To inform the bills, Rep. Roskam said he sought feedback from doctors, pharmacists, hospitals and families in his district. He said “excellent solutions that encourage the use of alternative treatments, increase provider education and assist with detection of those who are at-risk” were heard during such discussions.

“Addiction knows no color, gender or political affiliation; we have millions of Americans suffering in pain who have fallen into a cycle of addiction,” the congressman added. “These bills address some of the most common causes of opioid dependency at their inception.”

Supporting information also was gleaned during the May 8 House Ways and Means Health Subcommittee hearing on the Medicare Advantage Program, at which Chairman Roskam and other lawmakers focused on opportunities to improve and expand the program, reviewed obstacles for consumers, and discussed high-performing and emerging plans.

Almost 40 percent of Medicare beneficiaries with Parts A and B coverage are enrolled in a Medicare Advantage plan, according to Rep. Roskam’s staff, who said American healthcare consumers are better shoppers when they’re sufficiently informed about their choices regarding cost, quality and benefits included in their Medicare options.

And with Medicare Trustees continuing to project increasing numbers of United States senior citizens will choose a Medicare Advantage plan in the coming years, Rep. Roskam said, “We want to see the benefits offered to seniors and adults with disabilities through the Medicare Advantage Program expanded to help more patients and the first step in making that happen is evaluating the outcomes that are currently being generated by the program.”

Dr. Karoline Mortensen, associate professor of health sector management and policy at the University of Miami Business School, testified that “a lot of the plans would like to see these measures as well.”

“Outcome measures provide insight into the quality of care provided, but one downside is that they can be influenced by factors that happen outside of the healthcare system, like patient compliance or issues with social determinants of health,” Dr. Mortensen testified.

Other witnesses at the hearing included Andrew Toy, chief technology officer at Clover Health; Daphne Klausner, senior vice president of senior markets at Independence Blue Cross; and Jack Hoadley from the Georgetown University Health Policy Institute.