A 21st-Century Cure for Prescription Drug Abuse

This week, the House Energy and Commerce Committee held a markup on the 21st Century Cures Act, legislation designed to speed the discovery, development, and delivery of lifesaving drugs and devices. As part of this proposal, legislators included provisions that can help address America’s prescription drug abuse epidemic.

More than 16,000 people die each year in the United States from opioid-related prescription drug overdoses¹—an increase of more than 300 percent since 1998. And the rate at which health care professionals prescribed these drugs quadrupled between 1999 and 2010². In 2011, nearly a quarter of a million Medicare beneficiaries took potentially life-threatening doses of opioid pain relievers for extended periods.³

The 21st Century Cures Act, which has broad bipartisan support, would provide new tools to help prevent inappropriate use of pain medications while ensuring access to the drugs for patients who legitimately need them.

The bill authorizes Medicare to use drug management programs to curb potentially harmful use of opioids and other controlled substances. These programs—also known as patient review and restriction programs—are currently used in several state Medicaid and private insurance plans to assign patients considered at risk for prescription drug abuse to specific prescribers and pharmacies. The programs improve continuity of care by ensuring that high-risk patients obtain and fill prescriptions for controlled substances only from designated providers.

The drug management programs also provide patient protections, including allowing beneficiary input on the selection of prescribers and pharmacies; providing the opportunity to appeal enrollment in the program; and excluding patients who require intensive or high-dose pain therapy, such as those receiving cancer treatment or hospice care.

The programs have helped state Medicaid plans decrease narcotic prescriptions and reduce patients’ visits to multiple providers and emergency rooms to obtain these drugs while also generating cost savings.⁴ Support for the drug management protocols continues to grow. For example, the House and Senate put forth policy proposals, and the Department of Health and Human Services provided funding for the programs in its fiscal year 2016 budget request. In addition, leading health care stakeholders—including the National Coalition on Health Care, the Academy of Managed Care Pharmacy, the Blue Cross Blue Shield Association, CVS Health, and Express Scripts—have voiced support for the protocols in Medicare.

Allowing Medicare to implement patient review and restriction programs would help protect beneficiaries and curb unnecessary deaths from prescription drug abuse. Pew looks forward to working with the House Energy and Commerce Committee to continue advancing this important public health initiative.

Endnotes

1. Centers for Disease Control and Prevention, “QuickStats: Rates of Deaths from Drug Poisoning and Drug Poisoning Involving Opioid Analgesics—United States, 1999–2013,” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a10.htm?s_cid=mm6401a10_e.
2. Centers for Disease Control and Prevention, “Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008,” Morbidity and Mortality Weekly Report 60 (2011): 1–6, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm.
3. Centers for Medicare & Medicaid Services, “Supplemental Guidance Related to Improving Drug Utilization Controls,” correspondence from Cynthia G. Tudor, director, Medicare Drug Benefit and C and D Data Group, Sept. 6, 2012, http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/HPMSSupplementalGuidanceRelated-toImprovingDURcontrols.pdf.
4. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Patient Review & Restriction Programs: Lessons Learned From State Medicaid Programs (Atlanta: 2012), http://www.cdc.gov/homeandrecreationalsafety/pdf/PDO_patient_review_meeting-a.pdf.