The Trump Administration’s Opioid Strategy: What Do States Need to Know?
On March 19, 2018, President Trump launched his opioid strategy. Within this Strategy, there are three main principles:
1. Reduce demand for legal and illegal drugs
2. Reduce the supply of legal and illegal drugs
3. Use evidence-based treatments for addiction
States should be aware that within this three-pronged approach, the Administration’s goal is to ensure that within three years, 75 percent of opioid prescriptions “reimbursed by the federal government” are consistent with evidence-based prescribing and 95 percent within five years. It is unclear at this time which programs this will impact: presumably Medicare, but possibly also Medicaid and CHIP, some of the individual market (i.e., “Obamacare”), the Veterans Administration providers, Department of Defense’s Tri-Care, the Federal Employee’s Health Benefits Program, the Indian Health Service, and the system of safety net hospitals and clinics that are heavily subsidized by the federal government (e.g., FQHCs, RHCs, public hospitals). Note that several of these programs use managed care, or health plans, to deliver benefits and the federal government has slightly less control of practitioners’ prescribing patterns without a great deal more oversight and data reporting. It remains to be seen how the Administration plans to collect data and measure success.
Additionally, there is expected to be additional federal funds for Prescription Drug Monitoring Programs. The Strategy also suggested there will be additional funds to states to improve overdose tracking systems thereby properly allocating resources.
The President reiterated that the Administration would work with states to waive reimbursement policies for certain treatment facilities. In November, the Administration issued a State Medicaid Director’s Letter (i.e., policy guidance) suggesting that the Centers for Medicare and Medicaid Services (CMS) is open to considering waiving existing reimbursement policies for treatment facilities known as Institutions for Mental Disease (IMD). There is a prohibition in the Social Security Act for federal Medicaid payment to these residential facilities, yet they are critical in the rehabilitation of some individuals with substance use disorders. The Strategy also notes that modifying the Social Security Act to remove this prohibition will be critical too.
Finally, there were references to offering treatment more readily to those in need. This implies more federal funding opportunities to increase services, but it was not explicitly spelled out how or when that would happen.