CMS Proposes Opioid Controls for Medicare Plans

The Trump administration has proposed new steps to discourage opioid abuse in Medicare Advantage and Part D, including extra surveillance and expanded use of non-opioid pain treatments, reports Politico Pro . As part of its 2020 draft call letter , the U.S. Centers for Medicare and Medicaid Services (CMS) encouraged private Medicare plans to adapt benefit designs to promote non-opioid therapies and treatments such as peer support services, cognitive behavioral therapy, and therapeutic massage, if recommended by a physician. The agency also is urging Part D sponsors to supply overdose treatments, including at a lower cost-sharing rate to encourage access. CMS also advises co-prescribing naloxone with opioids to persons deemed high-risk, and has requested comments on how to feasibly implement co-prescribing. CMS vowed that it would not approve benefit designs that discouraged enrollment by beneficiaries that require medication-assisted treatment for their addiction. Star Ratings for Medicare Advantage sponsors also will have more varied language on potential opioid misuse. Ratings currently featuring a measure for high-dosage opioids use from multiple providers would be divided into two separate measures, and be capable of flagging concurrent use of opioids and benzodiazepines. Over the coming months, CMS' National Committee for Quality Assurance will discuss non-opioid chronic pain options with plans and providers to potentially develop new measures for therapy rollout in 2021.