POLICY BRIEFINGS


Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


THIS WEEK'S BRIEFING - NOVEMBER 5, 2018


CMS Publishes 2019 Physician Fee Schedule


The Centers for Medicare and Medicaid Services (CMS) has finalized a new payment rule that will cut reimbursement for new physician-administered drugs in Medicare Part B. CMS will pay physicians at the wholesale acquisition cost (WAC) plus three percent for 2019 under the latest Medicare physician fee schedule (MPFS) final rule. The program currently pays the WAC plus six percent for the first three months that a physician-administered drug is on the market. According to the agency, the change is an attempt to align government payment rates with drug acquisition costs and to reduce drug spending.


Opioid-Related News Update


Effective November 1, the state of Oklahoma will require physicians to limit initial opioid prescriptions to seven days. Under a new law that went into effect on Thursday, Oklahoma will also require doctors to participate in educational training in an effort to keep prescribers up to date with the latest information on opioids. When physicians apply for a license renewal, they will be required to receive no less than one hour of education in pain management, opioid use, or addiction each year before completing their application.

While Georgia made it mandatory for prescribers to register with the state’s prescription drug monitoring program (PDMP) 10 months ago, more than 1,000 doctors and physician assistants (PAs) may still be prescribing opioids, without having registered with the database. The registration deadline for those with a license from the federal Drug Enforcement Administration (DEA) to prescribe controlled substances was January 1 of this year, and prescribers were required to begin checking patients’ prescription histories with the PDMP on July 1. State lawmakers are in discussion with Georgia’s medical licensing board to ensure that prescribers are in compliance with the law before the state Senate agrees to a budget increase being pushed by the medical board. LaSharn Hughes, Executive Director of the Georgia Composite Medical Board, insists that overall compliance among doctors, PAs, pharmacists, dentists, and nurses with prescribing authority is estimated to stand at 95 percent. The Board, which was charged with enforcing the law, is in the process of determining why the remaining 1,400 individuals have not registered with the PDMP. Hughes has stated that the unregistered doctors and PAs may have good reason for not being registered – they may not prescribe controlled substances or are involved in public health instead of the practice of medicine.

The Food and Drug Administration (FDA) approved a powerful new opioid last week. Commissioner Scott Gottlieb acknowledged concerns about the abuse potential for Dsuvia but noted its important potential for meeting an unmet medical need for the nation’s military. Dsuvia is administered under the tongue rather than injected, making it more suitable for battlefield situations. The product will only be authorized to be administered by health care professionals.



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