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Threat of Sequestration Ends with Bipartisan Budget Act White House and Congressional leaders agreed to large increases in base funding for defense and nondefense spending on Thursday, with the expectation of support by the Senate in a vote next week. The budget deal establishes a funding base above spending cap levels that could trigger mandatory automatic spending cuts, referred to as sequestration. The bipartisan compromise suspends the federal debt ceiling and spending caps for two years, thus marking the end of sequestration that was due to sunset in 2021. Defense spending was increased by $22 billion and nondefense spending was increased by $27 billion. As part of the negotiations, Congressional leadership agreed to avoid the inclusion of any contentious measures that do not have bipartisan support during the FY2020 appropriations process. This agreement will allow for a budget process that will avoid a government shutdown. Medicare Plans Dramatically Reduce Prior Authorization Rates A recent study published in a JAMA Research Letter found large reductions in the percentage of Medicare Part D and Medicare Advantage Plans using prior authorization for buprenorphine medications for opioid use disorder (OUD). In the two years between 2017 and 2019, the percentage of plans using preauthorization for generic buprenorphine-naloxone medications dropped from 96 percent to zero, and for brand buprenorphine-naloxone medication rates dropped from 88 percent to 3 percent. These findings follow two federal policy initiatives: a 2017 buprenorphine labeling change by the Food and Drug Administration, and a 2018 announcement by the Centers for Medicaid and Medicare Services (CMS) that they would no longer approve Medicare Part D formularies that preauthorize buprenorphine products more than once per year. Looking forward, the study states the importance of the data “because Medicare policy is often viewed as a standard that is subsequently adopted by private health plans and Medicaid.” Tami Mark, lead author of the study said, “Although Medicare has significantly reduced prior authorization for opioid use disorder medications, it is still in common use in Medicaid and private health plans.” Legal Action Center Calls for Removal of Prior Authorization in Medicaid The Legal Action Center (LAC) in a new report calls for Medicaid programs to adopt the successful “Medicare Model” of eliminating prior authorization for medications to treat opioid use disorder (OUD) and expanding coverage of all FDA-approved medications. Citing the success of a 2018 federal policy that virtually eliminated prior authorization for buprenorphine products in Part D and Medicare Advantage programs (see previous article), LAC reports that most Medicaid plans continue to require prior authorization for OUD medications. Specifically, buprenorphine-naloxone medication requires prior authorization in 40 Medicaid programs, and buprenorphine medication requires authorization in 35 Medicaid programs. Formulary restrictions and dose limitations also pose barriers to medication assisted treatment (MAT). MAT can reduce mortality by almost half. Medicaid covers four out of 10 adults with OUD and thus “plays a significant role in delivering effective OUD treatment and reducing barriers to FDA-approved medications,” the report states.  The Report recommends that CMS issue a guidance letter to State Medicaid Directors to increase the use of all medications for OUD. Arnold Ventures Funds Research on Insurance Fraud Arnold Ventures is funding a new two-year study to develop methods for identifying fraudulent opioid use disorder treatment and recovery services. Led by Boston University researchers and in collaboration with a former federal health-fraud investigator, the study intends to provide a broader view of fraudulent practices, including excessive medical testing, patient brokering, and the geographic scope of such practices. Through a review of insurance data for more than 50 million individuals and the deployment of secret shoppers, the study seeks to provide insurance companies with tools to improve detection and support policymakers in developing procedures to improve oversight. Fair Health Sheds Light on Rapid Growth of Telehealth A new white paper from FAIR Health found that provider-to-patient telehealth grew by 1,293 percent for non-hospital-based providers between 2014 and 2018, accounting for 84 percent of all telehealth claim lines. Telehealth for all providers grew by 624 percent. In a review of over 29 billion private claim records for 2018, the analysis found that mood disorders (six percent) and anxiety and other nonpsychotic mental disorders (five percent), were the second and third most common conditions for which individuals sought telehealth services. Upper respiratory infections were the most common reason. Telehealth gains were larger for urban providers, increasing 1,227 percent, with rural providers increasing by 897 percent. Rural areas, however, showed stronger gains than urban areas for telehealth after hospital discharge, with an increase of 407 percent. A previous FAIR Health study found that between 2016 and 2017, telehealth grew more than any other place of service, including emergency rooms and retail clinics. According to FAIR Health, the findings suggest “important implications for improving healthcare quality and lowering costs by reducing avoidable hospitalizations, readmissions and urgent/emergent care visits.” National Institutes on Drug Abuse to form Justice Community Opioid Innovation Network Ten research institutions and two centers have been funded by the National Institutes on Drug Abuse (NIDA) to support research on treatment for opioid use disorder (OUD) in criminal justice settings. Twelve grants were awarded to develop a Community Opioid Innovation Network (JCOIN) to shore up the response capacity of the justice system to the opioid epidemic. Awards total approximately $155 million for a multi-year initiative in which research investigators will collaborate with justice and behavioral health stakeholders to identify promising interventions on adoption of new medications, retention of individuals in treatment, and preventing relapse after community re-entry. JCOIN is part of the National Institute of Health grants called HEAL (Helping to End Addiction Long-term Initiative). SAMHSA Suicide Prevention Resource Center Hosts Webinar The Suicide Prevention Resource Center (SPRC) will host a webinar on the intersection between serious mental illness (SMI) and suicide Monday, July 29 at 4:30 p.m. ET. Webinar panelists will present an overview of approaches to addressing suicide risk for patients diagnosed with SMI who are seen in health and behavioral health organizations. Individuals with SMI are at higher risk of dying by suicide. Informational resources will be shared, as well as tailored interventions, methods of engagement, and supporting family and friends. SPRC is funded under a grant by the Substance Abuse and Mental Health Services Administration to advance the implementation of the National Strategy for Suicide Prevention. For questions or comments about CEO Update, please contact Jessica Zigmond.