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Removing barriers to prevent and treat opioid abuse and dependence in Medicare

February 08, 2018 | Diversity Equity Inclusion


America’s addiction crisis has led to the first two-year consecutive decline in our country’s life expectancy since the 1960s, Aetna’s Executive Vice President and Chief Medical Officer Hal Paz told the House Ways and Means Committee yesterday during a hearing entitled “Removing Barriers to Prevent and Treat Opioid Abuse and Dependence in Medicare.”

House leaders are asking Aetna and other health care stakeholders for help in combatting the opioid crisis and, specifically, about any opportunities to improve Medicare’s coverage of treatment.

In his testimony, Paz outlined the holistic approach Aetna is taking to address the opioid epidemic, including enhancing programs to reduce inappropriate opioid prescribing, encouraging the use of non-opioid pain treatment modalities, and promoting evidence-based treatment for members struggling with opioid use disorder.

For example, as of Jan. 1, Aetna is limiting initial opioid prescriptions for acute pain to a seven-day supply in its commercial business. These stricter daily and dosage limits are in alignment with CDC guidelines, and will help reduce the potential for abuse and addiction. Aetna also became the first and only national payer to waive copays for Narcan— a lifesaving, highly effective opioid overdose reversal agent—for fully-insured commercial members once their deductible is met.

“Our important efforts in our Commercial lines of business, for example, can inform how the Centers for Medicare and Medicaid Services (CMS) regulate Medicare Advantage (MA) and Part D plans to allow for similar programs in the Medicare space,” he said.

In addition, in Medicare, Aetna has also taken steps to promote appropriate prescribing and coordination of care for its members who use opioids. With CMS approval, Paz noted that Aetna has instituted utilization management tools in its Medicare formularies to support appropriate and safe prescribing and dispensing of opioids and identify potential inappropriate use.

Paz suggested that Congress and CMS can take additional steps to help Medicare plans improve coverage of treatment, specifically:

  • Finalizing provisions that would limit initial opioid prescriptions to a seven-day supply, in alignment with CDC guidelines
  • Ensuring success of Medicare Part D lock-in mechanism (by which a member can be “locked in” to one pharmacy to prevent “pharmacy shopping”) and providing greater flexibility to Medicare Advantage and Part D plans
  • Modernizing privacy regulations to ensure that providers and organizations have all the information necessary to provide safe, effective, high quality care

“Aetna is deeply committed to doing its part to reverse the trend of opioid misuse, abuse, and overdoses across the nation,” Paz said. “We look forward to continuing to play a productive role in the dialogue with the Committee and with other policymakers to help find solutions to this epidemic.”