Last week, the Biden Administration’s Office of National Drug Control Policy (ONDCP) released its drug policy priorities for year one of the new administration. This list of priorities, which is required to be submitted to Congress April 1st of an inaugural year, includes a host of policies that, if carried out, have the potential to affect you as emergency physicians and your patients. Many of the policies and priorities align with ACEP’s overall goals around improving access to treatment of patients with opioid use disorder (OUD)—and I would like to highlight some of these.
ONDCP lists removing “unnecessary barriers to prescribing buprenorphine and identify(ing) opportunities to expand low-barrier treatment services” as one of its policy objectives. As you may recall from a previous Regs & Eggs post, in January 2021, the Biden Administration announced that it would not finalize practice guidelines issued during the last few weeks of the Trump Administration that would have effectively eliminated the “X-waiver” requirement for physicians prescribing buprenorphine. In making that announcement, the U.S. Department of Health and Human Services (HHS) and ONDCP stated that although they could not finalize the guidelines, they were “committed to working with interagency partners to examine ways to increase access to buprenorphine, reduce overdose rates and save lives.”
This commitment made in January and the policy priority issued last week are both positive signs that the administration is serious about addressing barriers to OUD treatment, such as the X-waiver. However, it remains to be seen whether the administration will follow through on the priority. ACEP recently reached out to HHS to see what actionable steps (if any) HHS is planning on taking and we hope to hear back soon. I’ll keep you updated!
COVID-19 Pandemic Flexibilities
ONDCP plans to “evaluate and explore making permanent the emergency provisions implemented during the COVID-19 pandemic concerning ‘medications for opioid use disorder (MOUD)’ authorizations, including allowing providers to begin treating patients with MOUD by telehealth without first requiring an in-person evaluation, as well as evaluating and ensuring the continuation of Medicaid and Medicare reimbursements for these telehealth services.“ As background, federal agencies such as the Drug Enforcement Administration (DEA) have taken steps to reduce barriers and provide additional flexibility during the pandemic. The DEA has adopted protocols to allow DEA-registered practitioners to prescribe controlled substances to their patients without having to interact in-person with their patients. Under the DEA’s policy (which became effective on March 31, 2020), authorized practitioners can prescribe buprenorphine over the telephone to new or existing patients with OUD without having to first conduct an examination of the patient in person or via telehealth. Actions such as this one have helped both patients and medical personnel and have reduced barriers to OUD treatment during the pandemic. It will therefore be interesting to see whether the Biden Administration decides to make some or all of these flexibilities permanent.
ONDCP also includes a policy priority around access to naloxone—a life-saving medication that when used properly can reverse opioid overdoses and save lives. ACEP has been actively trying to increase awareness about the benefits of naloxone and in the past has strongly advocated for the HHS to take steps to ensure that the medication is affordable and available to all communities. Recently, federal agencies within HHS have taken meaningful steps to promote the use of naloxone. The Centers for Medicare & Medicaid Services (CMS), for example, is now allowing opioid treatment programs (OTPs) to offer naloxone to Medicare beneficiaries as part of a new benefit that CMS established to provide treatment to patients with OUD. It is important to note that this benefit only applies to services delivered by OTPs. ACEP believes that some of these services allowable under the benefit, such as the administration of naloxone, should also be paid for when delivered in the emergency department (ED). We have specifically requested that CMS institute a policy that would allow EDs to get reimbursed for administering naloxone and emergency physicians and other clinicians working in EDs to get compensated for the time that is spent counseling patients on how to appropriately use naloxone at home. We hope that CMS will include such a policy in the next physician fee schedule regulation.
There are many other policies in this priority list beyond the few I’ve touched upon, including an extremely important goal of advancing racial equity in the administration’s drug policies. If there are others you think ACEP should explicitly weigh in on and advocate for or against, please let me know!
Until next week, this is Jeffrey saying, enjoy reading regs with your eggs.