On Oct. 24, President Donald Trump signed the SUPPORT for Patients and Communities Act, bipartisan legislation to address the nation’s growing opioid crisis and reduce overdose deaths. The law takes a multifaceted approach to prevent opioid misuse and expand access to effective treatment for opioid use disorder (OUD) and should help curb this serious public health problem, which kills 115 people each day.
The legislation contains multiple provisions that will expand and ensure access to evidence-based treatment for OUD. It takes important steps to better coordinate care and facilitate access to appropriate treatment based on patients’ unique needs. Among its provisions, the act will:
Ensure Medicare coverage of methadone for opioid use disorder. Although more than 777,000 adults age 65 or older misused opioids in 2017, the federal health insurance program for older Americans did not pay for outpatient OUD treatment using methadone, one of three Food and Drug Administration (FDA)-approved medications for the disorder. The law makes methadone a covered Medicare benefit and will allow beneficiaries to receive this treatment in state and federally regulated opioid treatment programs that provide the medication and other services for OUD.
Expand the ability to prescribe buprenorphine. To provide buprenorphine, another FDA-approved medication for OUD, prescribers must follow federal restrictions. The law permanently allows nurse practitioners and physician assistants to prescribe the medication and creates a five-year trial period during which other providers, such as clinical nurse specialists, can become qualified prescribers. It also increases the number of patients whom individual providers can treat with buprenorphine.
Increase access to inpatient treatment through Medicaid reforms. The right type of care for those receiving OUD treatment depends on many factors, including disease severity, other existing disorders, and the stability of a patient’s personal circumstances. Outpatient or community-based settings may provide appropriate care for most patients, but others may need inpatient treatment. The law loosens federal restrictions on Medicaid funds used for residential treatment centers with more than 16 beds. More importantly, it ensures that residential treatment is part of a continuum of services that includes outpatient treatment, and takes steps to ensure that each patient receives appropriate care.
Improve support for those re-entering their communities from custody. People getting out of prisons are more than twice as likely to die from an overdose than any other cause in the first week after their release. The legislation promotes innovative state strategies to help Medicaid-eligible incarcerated individuals make the transition back into their communities by requiring the Centers for Medicare & Medicaid Services to issue best practices to help states design demonstration projects to improve care transitions for those being released from custody.
Increase the transparency of interactions between prescribers and drugmakers. Nurse practitioners and physician assistants write substantial numbers of opioid prescriptions in the United States. Increased transparency regarding gifts and payments to these providers from drug and device manufacturers can help reduce the harms of opioid misuse. The law imposes the same level of transparency that is already required for physician prescribers.
The opioid crisis continues to ravage families and communities, with too many people unable to access the evidence-based treatment that OUD requires. This legislation is an important step in turning the tide on this public health crisis and reducing overdose deaths. Now care providers, families, and individuals will have better tools to ensure increased access to the help that is desperately needed.
Allan Coukell is senior director of health programs at The Pew Charitable Trusts.