U.S. Sen. Shelley Moore Capito (R-WV) seeks changes to Medicare’s current reimbursement policy, which includes a cost disparity between opioid-based pain medication and non-opioid drugs used to treat post-surgical pain.
The cost disparity has created a disincentive for providers to use the less addictive non-opioid alternatives, according to the senator’s office.
“Addressing the opioid epidemic requires a multifaceted approach,” Sen. Capito said. “A critical part of this is ensuring that the Medicare program does not create a perverse incentive for doctors to continue to prescribe opioids to patients.”
Sen. Capito and U.S. Sen. Jeanne Shaheen (D-NH) sent an Oct. 10 letter to U.S. Department of Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma requesting information from CMS regarding its review of Medicare payment policies.
“In order to prevent the next generation of substance misuse, it will be critical to make certain that appropriate incentives are in place so that patients can receive non-addictive pain treatments, particularly during and after surgery,” the senators wrote.
In most cases, the Medicare program pays the same amount for outpatient surgeries, regardless of what pain management is used to treat post-surgical pain, according to their letter. And because non-opioid drugs and devices used to treat pain after surgery are not separately reimbursed, healthcare providers tend to prescribe low-cost, highly addictive opioids to keep their facility’s expenses for the procedure below the Medicare payment amount, they wrote.
“Instead, we should incentivize providers to utilize innovative non-opioid drugs and devices,” said Sen. Capito. “In doing so, we can ultimately save much-needed dollars for our health care system while also addressing this issue.”
Sen. Capito and her colleague also reminded Azar and Verma that the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act requires CMS to review payments to ensure no financial incentives exist to use opioids rather than non-opioid alternatives, and they requested that CMS provide details on its review process.
“We urge CMS to examine the evidence to ensure that reimbursement policies are working in the best interests of patients,” wrote the senators.