Stemming a Deadly Epidemic
In 2016, a stunning 42,000 Americans died from opioid overdoses. Opioid addiction has become national news in recent years, as political candidates, medical groups, and others have introduced proposals on how to drive down the number of people who are at risk for addiction and overdose.
Some of those efforts have begun to work, due to increased public and medical community awareness, and more intensive medical review and utilization management efforts by payors, pharmacy benefit managers, and medical provider networks. Still, employers have had many reasons to be concerned. The abuse of opioid prescriptions impacts employers through the devastation it can wreak on employees and their families, as well as through the cost impact to employers’ health insurance and workers’ compensation insurance plans. According to the Kaiser Family Foundation, the cost of treating addiction and overdoses associated with opioids have increased more than eight-fold, from $300 million in 2004 to $2.6 billion in 2016. Despite the success of efforts to drive down the use of opioids in the wake of work-related injuries, the California Workers’ Compensation Institute (CWCI) found last year that opioids are still the most common type of prescription drug used to treat California injured workers with lost-time injuries. Opioids made up nearly a quarter of the indemnity claim prescriptions in 2017. There is definitely room for improvement.
In the last year, lawmakers have tried to impact the opioid crisis through a series of efforts at the state and federal level to give doctors and payers more tools and give people with addictions more resources.
Most recently, Congress enacted the “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act” (SUPPORT Act), a comprehensive, bipartisan bill addressing the opioid crisis. President Trump signed the legislation into law on October 24, 2018. The SUPPORT Act is made up of dozens of smaller bills addressing various aspects of the opioid crisis – from coverage to treatment, to research, recovery and law enforcement. It contains a number of provisions aimed at providing better coverage for substance use disorder treatment through the Medicare and Medicaid programs, including expanded coverage for telehealth under those programs.
The SUPPORT Act also has provisions aimed at:
facilitating better data sharing among state agencies, federal government health programs, drug manufacturers, distributors and researchers
supporting state-based prescription drug monitoring programs (PDMPs), including linking PDMP data to other data systems within the states, including the data of pharmacy benefit managers (PBMs) and workers’ compensation data
enhancing law enforcement with regard to interdiction, illicit imports and suspicious orders
increasing the number of practitioners available to treat substance use disorders
funding research into better treatment options both for pain and substance use disorders
establishing and/or funding treatment and recovery centers
aiding persons in recovery in reentry into the workforce and stable housing
California enacted its own group of new laws aimed at combating the opioid crisis this year. On October 2, 2019 the state’s mandate for prescriber use of the Controlled Substance Utilization Review and Evaluation System (CURES) database went into effect. Additionally, the following bills were signed into law in 2018:
AB 1751—Requiring the state Department of Justice (DOJ) to adopt regulations by July 1, 2020 regarding the access and use of the information within CURES.
AB 1753— Allowing the DOJ to cap the number of security printers approved to manufacture regulated prescription pads and requiring prescription pad serial numbers to be linked to corresponding records in the CURES database.
AB 2086— Allowing prescribers to access CURES for a list of patients for whom that prescriber is listed as a prescriber in the database.
AB 2487—Authorizing a doctor to complete a one-time continuing education course of 12 credit hours in the subjects of treatment and management of opiate-dependent patients, including eight hours of training in buprenorphine treatment, or other similar medicinal treatment, for opioid use disorders as an alternative to the required CE course on pain management and the treatment of terminally ill and dying patients.
SB 1109— Requiring warning labels for opioid prescription drug containers, and the provision of the Opioid Factsheet for Patients to all athletes engaged in after-school youth sports.
Additional information on the bills listed above can be found in our comprehensive Briefing on state legislation. In light of the many provisions in the SUPPORT Act that provide funding for research and treatment, it is likely that California lawmakers will continue to introduce bills that take advantage of the opportunity to draw down federal funds to further combat the crisis. With community groups, researchers, payors, providers, employers and lawmakers all working together to combat the rise in opioid use disorders, we are hopeful that we will soon be able to make a meaningful impact on the crisis.