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CMS Proposes Lower Cost-Sharing for Naloxone

WASHINGTON — Medicare beneficiaries at risk for opioid overdose may see reduced cost-sharing for naloxone under a proposed policy announced by the Centers for Medicare & Medicaid Services (CMS), in response to calls to make the overdose-reversal agent more widely available.

“The agency is continuing to work to combat the nation’s opioid crisis,” said Demetrios Kouzoukas, director of the Center for Medicare at CMS, on a phone call with reporters Wednesday. “Many new policies are being implemented in 2019, including Part D drug management programs for high-risk opioid users and improved safety alerts such as a 7-day supply limit for opioid-naive patients. CMS will evaluate the success and impact of these policies in 2019 and is proposing to continue them into 2020.”

Such policies have borne fruit, the agency said. “CMS’ overutilization policies have resulted in a 14% decrease in the share of Part D beneficiaries using opioids between 2010 and 2017 (36.3% to 31.3%), with the largest decrease from 2016 to 2017 (5%),” CMS noted in a press release.

In addition to that, “CMS is also taking steps to clarify that the new benefit flexibilities outlined earlier can be used to offer targeted benefits or cost-sharing reductions to patients with chronic pain or who are undergoing addiction treatment,” he continued. “Separately, we are also aiming to empower beneficiaries and caregivers to prevent opiate overdoses by encouraging Part D plans to provide lower cost-sharing for opioid-reversal agents such as naloxone.”

The cost-sharing reduction is not mandatory, and it wouldn’t help the vast majority of those at risk for overdose: people ages 65 and older had by far the lowest rate of fatal drug overdoses among all age groups in 2017, according to the CDC.

Kouzoukas told MedPage Today that CMS is open to looking at other populations for the reduced cost-sharing. “[This proposal] is specific to the Medicare program but we are obviously considering any and all initiatives that might help address the opioid issue in any context,” he said.

Enhancing Medicare Advantage

Medicare also announced that it was proposing to allow Medicare Advantage plans to offer enhanced supplemental benefits beginning in 2020. “[Medicare Advantage] plans have been historically limited to offering ‘primarily health-related’ supplemental benefits … but thanks to changes we’ve made to the types of benefits that can be considered primarily health-related, Medicare Advantage plans are now providing enrollees this year with access to new types of benefits and services,” said Kouzoukas. “Today, CMS is taking action to further expand that flexibility to additional enrollees and new kinds of benefits, specifically for the chronically ill population.”

In the proposal, for the 2020 plan year and beyond, “Medicare Advantage plans will have greater flexibility to offer chronically ill patients any benefit that improves and maintains their health,” he continued. “For example, plans could provide home-delivered or special meals in a far broader set of circumstances than what is allowed today.”

The Better Medicare Alliance, a group of Medicare Advantage plans and providers, applauded CMS’s proposals. “We are encouraged by CMS’ proposals to allow Medicare Advantage plans and providers greater flexibility to meet the needs of chronically ill beneficiaries with the expansion of supplemental benefits,” said alliance president and CEO Allyson Schwartz. “As a coalition that includes Medicare Advantage plans, providers, and community partners, we know that there is keen interest in addressing the needs of this complex population by expanding access to nutrition, meals, transportation, and home care services.”

As for the proposed opioid policy, “Evidence has shown that beneficiaries in Medicare Advantage experience lower rates of opioid use,” she said. “CMS’ proposals will build on this success by increasing access to effective treatments for opioid addiction and promote non-opioid therapies available in Medicare Advantage.”