Medicare Pays for Opioids Over Alternatives, Lawmakers Say

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By Alex Ruoff

Medicare and Medicaid payment rules may be to blame for the overprescribing of opioids, two House Republicans told the head of the Department of Health and Human Services Feb. 14.

House lawmakers are probing how Medicare payment rules in particular influence how doctors prescribe pain treatment and whether those rules need to change to encourage nonaddictive alternatives to opioids, Rep. Erik Paulsen (R-Minn.) told Bloomberg Law Feb. 14. He said he plans to work with the HHS on the issue.

“The easy answer is just prescribe more drugs, but in this age of innovation we have FDA-approved devices that can help people with pain as well,” Paulsen said.

Medicare and many Medicaid programs have long covered prescriptions for opioids for treating pain but not many other alternatives, Paulsen said.

Alternatives to opioids range from simple painkillers such as ibuprofen and injections of pain-reducing drugs to physical therapy and devices meant to ease pain. A November 2017 study by researchers at the Albany Medical College in Albany, N.Y., found many non-opioid painkillers were just as effective at treating pain as opioids.

Paulsen and Rep. Jim Renacci (R-Ohio) asked Health and Human Services Secretary Alex Azar during a House Ways and Means Committee on the HHS’s budget request for the next year whether the agency was considering changes to Medicare or Medicaid payment rules to encourage doctors to prescribe nonaddictive treatments for pain.

Azar said he didn’t know if Medicare or Medicaid payment rules were creating barriers to prescribing these alternative treatments. He said he would work with lawmakers to address the issue.

“It’s something we’re going to follow up and work with his team on,” Paulsen said.

The White House’s budget request would boost spending on opioid programs at the HHS by $10 billion, Azar said. He said the administration is also working to expand addiction treatment programs.

It’s unclear what changes could be made to Medicare payment policies or guidelines to combat opioid overdoses. Some in Congress are probing whether the public insurance program for seniors should pay more for addiction treatment while others are exploring how federal programs could promote the use of pain management services over potentially addictive drugs.

Rep. Richard Neal (D-Mass.), the ranking Democrat on the Ways and Means Committee, complained during a January hearing by the House Ways and Means Committee on opioids that Medicare does not cover many outpatient treatment programs for addiction, which is common treatment for long-term addicts.

Two federal watchdogs recently reported that more than 700,000 seniors were given high doses of opioid painkillers and were at risk of abuse largely due to operational gaps within Medicare.

According to a report from the Department of Health and Human Services Office of Inspector General, one in three Part D beneficiaries—more than 14.4 million people out of 43.6 million beneficiaries—received a prescription opioid in 2016 and there’s not sufficient monitoring to know how much of that was due to overprescribing practices, where doctors give patients too much of a drug.

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Brian Broderick at

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