Medicaid Plans Required to Cover MAT, Wraparound Services

Pursuant to Section 1006(b) of the SUPPORT for Patients and Communities Act, the Center for Medicaid sent a State Health Official letter providing guidance on implementation of the provision throughout the program. Within the scope of the SUPPORT Act provision, state Medicaid programs are now required to provide and cover medication-assisted treatment (MAT) and behavioral therapy for opioid use disorders.

The SUPPORT Act requires coverage of all “drugs and biologics approved or licensed by the FDA used for MAT to treat OUD,” which includes methadone, buprenorphine and naltrexone. As part of the drug labels and requisite patient needs, the MAT benefit also includes counseling services and behavioral therapy. These offerings include individual/group therapy, peer support services, and crisis intervention services.

Articles & Resources – State Health Official Letter: Mandatory Medicaid State Plan Coverage of Medication-Assisted Treatment

CMS Approves OK, ME Demo Programs to Improve Local Epidemic Response

Last month, the Centers for Medicare & Medicaid Services (CMS) announced it had approved two proposals under the ACA’s Section 1115 demonstration program aimed at improving access to medication-assisted treatment for individuals with substance use and opioid use disorders. The approvals in Oklahoma and Maine marks the agency’s 30th and 31st demos aimed at addressing the nation’s opioid crisis.

Both Oklahoma and Maine proposals aim to improve the care continuum for patients with SUD/OUD, particularly those that have experienced a recent overdose or relapse which required hospital or treatment facility-based interventions. Additional federal funding will now be made available in both states to facilitate the needs of healthcare providers and patients. In Oklahoma, the program will also improve access to treatment facilities for individual beneficiaries undergoing acute mental health crisis and facilitate timely inpatient services.

Articles & Resources

CMS Newsroom – CMS Announces Approval of Oklahoma & Maine’s Substance Use Disorder Demonstrations, the 30th and 31st to Expand Access to Combat the Opioid Crisis

LINK – Oklahoma 1115 Demonstration

LINK – Maine 1115 Demonstration

Justice Department Sues Walmart Over Role in Opioid Crisis

The Department of Justice announced last month that it had filed a civil complaint against national retailer Walmart for its alleged role in the nation’s opioid epidemic through improper controlled substance oversight and dispensation. According to the DOJ complaint, the actions taken by Walmart with respect to opioids led to “hundreds of thousands of violations of the Controlled Substances Act.”

The federal government alleges that Walmart knowingly filled thousands of controlled substance prescriptions that they knew to be for illegitimate, non-medical use. On top of the alleged lax oversight around dispensing controlled substances within the pharmacy, it is alleged that the company also failed to report hundreds of thousands of suspicious order reports through its warehouses.

According to some reporting conducted by NPR, linked below, pharmacists and others employed by Walmart acknowledged efforts to raise concerns with superiors and other senior staff at headquarters around such practices. Amid the red flags raised by Walmart pharmacists, reports indicate that the dangerous prescribing, which was alleged to fuel the opioid crisis, continued.

Each violation of the CSA could result in a civil monetary penalty of nearly $70,000 which would potentially translate into a multi-billion dollar payout.

Articles & Resources

DOJ Newsroom – Department of Justice Files Nationwide Lawsuit Against Walmart Inc. for Controlled Substances Act Violations

Wall Street Journal – U.S. Sues Walmart, Alleging Role in Fueling Opioid Crisis

Bloomberg – Walmart Accused in U.S. Lawsuit of Fueling Opioid Crisis

NPR – Former Walmart Pharmacists Say Company Ignored Red Flags As Opioid Sales Boomed

What We Read Last Week

Several articles were published last week pertaining to the opioid epidemic, covering a variety of different components of the issue. Links to relevant articles are provided below.

Articles & Resources

Nature – Advancing Digital Health: FDA Innovation During COVID-19

American Medical Association – Policy Road Map Shows the Way to End the Overdose Epidemic

ABC News – Mexico Fentanyl Seizures Soar by Almost 500% in 2020

Business Insider – Cuomo Prioritizes People with Drug Addictions in COVID Vaccine Rollout

Washington Post – Those Who Lied About Opioids Face Few Serious Consequences. No Wonder People Are Angry.

WSJ Opinion – How Government Subsidized the Opioid Crisis

Johns Hopkins School of Public Health – Recommendations for the Overdose Epidemic in the COVID-19 Pandemic

Law360 – Sacklers Talked Bankruptcy After 2007 Deal, Creditors Say

NY Attorney General Newsroom – Attorney General James’ Statement on Opioid Filings Detailing How Sackler Family Personally Ran Purdue Pharma and Directed Billions in Profits Into Personal Bank Accounts and Trusts

Los Angeles Times – San Francisco Struggles to Stem ‘Horrific’ Uptick in Opioid Overdoses, Drug Abuse

San Francisco Chronicle – Drug Overdoses in S.F. Kill  58 People in November as Fentanyl-fueled Crisis Breaks Records

NIH Newsroom – Infant Opioid Withdrawal Therapy Varies Widely by Treatment Site

CDC Newsroom – Drug-Impaired Driving in the United States

FDA Newsroom – FDA Takes Further Steps to Confront Opioid Crisis Through Risk Evaluation and Mitigation Strategy Programs

CMS Newsroom – 2021 Part D Drug Management Program Guidance

U.S. Attorney for the District of Wyoming – Rawlins Doctor Sentenced for Unlawful Distribution of Pain Pills

This Week’s Calendar – Welcome to 2021 and the 117th Congress

On behalf of the CEPOP team, we hope everyone had a happy and healthy holiday season. As we step into 2021 and the start of the 117th Congress, there are no relevant events or hearings noticed at this time. In the instance that there are any changes to the schedule for this week, we will make additional information available.

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