Medicare Continues to Incentivize Opioid Prescriptions – And the Cost is Astronomical

Lawmakers have time and again taken steps to reverse the course of the opioid addiction crisis. The only issue? The problem continues to get worse.

Over the last decade, Congress has dedicated hundreds of millions of taxpayer dollars to reactive measures that support first responders, increase access to substance use disorder treatment, and expand the availability of emergency treatments for overdose. Despite this hugely important work, we have proven that throwing money at this crisis will not make it go away. The epidemic has only worsened.

A newly-released congressional report uncovered that the economic toll of the epidemic on the U.S. was nearly $1.5 trillion in 2020 alone. This cost comes on top of the human toll associated with 81,000 opioid-related drug overdose deaths in the last year. Through it all, Medicare policy continues to encourage and incentivize the use of prescription opioids as the default pain management for patients.

Consider the impact this has on individuals like Kerri Rhodes from Richmond, Virginia. Kerri lost her son Taylor at the age of 20. After injuring his shoulder playing tennis in high school, Taylor was prescribed opioids to manage his postoperative pain. Taylor soon spiraled into substance use disorder and ultimately died from an opioid overdose. This story is all-too familiar for many other families: care decisions dictated by a lack of patient and provider choice or access to alternatives.

Data from the Centers for Disease Control and Prevention show that approximately 75 percent of the 107,600 overdose deaths in 2021 involved opioids. One American died every seven minutes due to opioids.

Every seven minutes.

Despite this reality, our healthcare system continues to incentivize prescription opioids as the first-line treatment for postsurgical pain. Because of how Medicare pays for such procedures, hospitals seek out the lowest-cost care options for patients, making postsurgical opioid prescriptions the status quo. As a result, nine out of ten patients leave the hospital with an opioid prescription.

As we enter the next wave of the opioid addiction crisis, which experts warn will “be worse than it’s ever been before,”  it’s time for Congress to take a different approach – one that can prevent substance use disorder and protect more Americans from the harms of accidental opioid overdose. Too many lives have been lost to stay the course, and new tactics must address the need to increase access to safer, non-addictive pain management options in the healthcare setting.

While the Food and Drug Administration (FDA) has taken steps to spur the development of non-addictive, non-opioid alternatives, we must do more to make patient choice a reality. Without sufficient reimbursement for these products in the outpatient setting, there is no incentive for industry to innovate in this space, and the current approach increases exposure to opioids in the hospital or ambulatory setting, leading to new persistent use for millions of surgery patients every year.

To combat this next wave, Congress is considering legislation that provides an upstream approach to preventing addiction in the first place. The Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (H.R. 3259/S. 586) expands access to FDA-approved non-opioid pain management options in outpatient surgical settings. The legislation would provide separate payment for non-opioid pain management options administered to postsurgical patients. In doing so, the legislation aims to treat all pain management approaches the same way – by providing separate payment for them – and by instantly increasing access to non-opioid pain management options for tens of millions of Americans.

Over 170 members of Congress have signed on to support the bipartisan bill. If passed, patients would be afforded choice in managing their pain, including the ability to choose from among non-addictive pain treatments. The NOPAIN Act will not limit access to prescription opioids for patients or providers, nor will it change how doctors treat pain. When it comes to acute pain management, the NOPAIN Act provides more choices for patients and providers. But it will take action to make it a reality – Congressional leadership must include the NOPAIN Act in an end-of-year legislative package.

By realigning Medicare incentives, Congress can change the trajectory of the opioid addiction crisis. When you’re used to looking at things the same way, the right answer can be elusive. So here it is: incentivize non-addictive treatments to protect more patients.

Chris Fox is the executive director of Voices for Non-Opioid Choices.