Medicare pays for opioids over alternatives, lawmakers say

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Lawmakers took a long-standing industry complaint to the Department of Health and Human Services this week, telling Secretary Alex Azar that Medicare and Medicaid favor opioid prescription over non-addictive alternatives for treating chronic pain.

Rep. Erik Paulsen (R-MN) told Bloomberg News that House lawmakers want to know how Medicare payment rules might encourage doctors to prescribe pain treatment.

”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 told Bloomberg.

During a House Ways and Means Committee meeting Wednesday examining next year's HHS budget, Rep. Jim Renacci (R-OH) asked Azar if the agency is considering changes to Medicare or Medicaid payment rules to encourage alternative treatments for pain.

Roughly half a million Medicare Part D beneficiaries receive high amounts of opioids, with nearly 90,000 of those at “serious risk” from the medications, the HHS Office of Inspector General warned last year. Its July report documented concerns over “extreme” painkiller use and questionable prescribing practices among healthcare providers.

The OIG also urged a “multifaceted approach” to combating the opioid epidemic, including improving pain management alternatives and public health surveillance.

This week, Azar said he would work with lawmakers to address the issue.

Doctors can prescribe less addictive pain medications, injectables or alternatives such as physical therapy or acupuncture to help patients deal with pain, but government payers (and insurers) don't always cover those approaches.

States also have varying rules on how pass-through dollars can be spent. In six states, Medicaid dollars can be used to fund acupuncture for patients with diagnosed low-back pain or migraines. In January, Ohio expanded its program to allow registered, non-physician acupuncturists to provide the service.