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
Medicaid.gov – 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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