Policy News Roundup: March 16, 2023

Key reads

Distributor requirements from opioid settlement are hindering access to medications

Nearly a year after the opioid settlement with pharmaceutical distributors imposed new requirements on the companies, patients are having difficulty getting medications to treat many conditions, including anxiety, ADHD and addiction. Distributors are placing stricter limits on medication supplies to pharmacies and heavily scrutinizing their dispensing activity. The oversight applies to an array of controlled substances that have the potential to be addictive or habit-forming. Tens of thousands of drug orders have been canceled, disrupting the flow of medication as the distributors navigate between implementing safeguards and making necessary medications available. The distributors are using algorithms that cap quantities of controlled substances a pharmacy can sell in a month. As a condition of the settlement, distributors cannot tell pharmacies what the thresholds are. Distributors are also monitoring the dispensing of certain combinations of substances (e.g., opioids and sedatives) and the filling of orders for people who live far away. Some doctors say legitimate prescriptions are being caught in the dragnet, and pharmacists are declining to dispense certain medications for fear of setting off triggers.

Source: Opioid Settlement Hinders Patients’ Access to a Wide Array of Drugs (The New York Times)

White House releases FY 2024 budget proposal

The President’s Budget for FY 2024 includes $10.8 billion for the Substance Abuse and Mental Health Services Administration. The budget contains increased funding for the Community Mental Health Services Block Grant, including an increase in the crisis care set-aside and a new set-aside for programs to support at-risk youth and adults; Certified Community Behavioral Health Clinics; 988 and crisis services; Project AWARE; care integration; State Opioid Response grants; and the Substance Use Prevention, Treatment and Recovery Support Block Grant, including a set-aside for recovery support services. It also includes a new program to support community harm reduction activities and linkages to services and seeks to update agency names to remove “substance abuse.” Biden’s budget also includes increased funding for research on the opioid and mental health crises, school mental health services and the behavioral health workforce. It proposes expanding mental health and addiction benefits and networks in Medicare, Medicaid and private insurance and increasing application and enforcement of parity. It would make permanent the expanded Affordable Care Act subsidies and expand coverage for people in states without Medicaid expansion. The budget is in effect a policy priorities document, as Congress is responsible for passing appropriations.

Source: SAMHSA Seeks $10.8 Billion in Fiscal Year 2024 to Bolster Mental Health and Substance Use Services Across the Nation (SAMHSA); HHS Releases President’s Fiscal Year 2024 Proposed Budget (HHS); FACT SHEET: The President’s Budget Reduces Deficits by Nearly $3 Trillion Over 10 Years (White House); Secretary Marty Walsh Addresses President Biden’s Fiscal Year 2024 Budget (Department of Labor)

DOJ sues Rite Aid for opioid dispensing practices

The U.S. government sued Rite Aid, accusing it of missing red flags as it illegally filled hundreds of thousands of prescriptions for controlled substances, including opioids. The Department of Justice (DOJ) said Rite Aid repeatedly filled prescriptions from May 2014 to June 2019 that were medically unnecessary, for off-label use or not issued in the usual course of professional practice. Rite Aid pharmacists were accused of ignoring obvious signs of misuse, including prescriptions for a combination of opioids, benzodiazepines and muscle relaxants. DOJ also said Rite Aid intentionally deleted some pharmacists’ internal warnings about suspicious prescribers. DOJ accused Rite Aid of violating the federal False Claims Act by submitting false prescription claims to government health care programs such as Medicare and Medicaid. It joined a whistleblower lawsuit filed in 2019 by two pharmacists and a pharmacy technician from Rite Aid stores.

Source: US sues Rite Aid for missing opioid red flags (Reuters)

White House and Mexican President take issue with GOP calls to designate drug cartels as terrorist groups

The White House batted down suggestions from some Republican lawmakers to designate Mexican drug cartels as foreign terrorist organizations. It argued it would not grant additional authorities that the administration does not already have and pointed to the U.S.’s sanctions authorities specifically designated to combat narcotics trafficking organizations and the individuals/entities that enable them. The Treasury Department has taken a series of actions sanctioning Mexican companies and individuals connected to the drug trade in recent months. Mexican President López Obrador also responded to the calls from Republican lawmakers, saying that his country does not produce or consume fentanyl and depicting the synthetic opioid crisis as a U.S. problem. López Obrador said Mexico would not accept threats from Republican lawmakers to use U.S. military action against drug labs in Mexico.

Source: White House: Labeling cartels as terror groups would have minimal benefit (The Hill); Mexican president to US: Fentanyl is your problem (Associated Press)

Department of Labor launches online dialogues on supporting workers' mental health

The Department of Labor announced the launch of a series of online dialogues to gather ideas and other public input on how health policies can support workers’ mental health most effectively. The crowdsourcing will focus on four areas of concern for people with mental health conditions – expanding access to workplace care and supports for people with mental health conditions; enhancing parity, benefits and equal treatment in the workplace; targeting underserved rural, racial and ethnic communities; and addressing behavioral health workforce shortages and establishing state resources systems. The dialogues will remain open until April 3. Input received will inform the next meeting of the Mental Health Matters: National Task Force on Workforce Mental Health Policy, April 29-30.

Source: US Department Of Labor Launches Online Dialogues To Gather Public Ideas, Other Input On Health Policies’ Support For Workers’ Mental Health (Department of Labor)

Colorado attorney general releases report on illicit drug activity on social media

Colorado Attorney General Phil Weiser released a first-of-its-kind report highlighting how the internet, particularly social media, is used for illicit drug activity. The report was called for by the fentanyl law the state passed last year. The report highlights that sellers rely on certain internet platform designs/features to facilitate sales. While most social media companies adopted policies banning the use of their platforms to promote, advertise, buy or sell illicit substances and made some efforts to work with law enforcement to address the issue, companies’ responses generally have been uneven and limited in effectiveness. The report provides recommendations for social media platforms and the state and federal governments.

Source: Attorney General Phil Weiser releases Colorado social media and fentanyl report (Colorado Attorney General)

North Carolina releases plan to invest $1 billion in behavioral health

North Carolina Governor Roy Cooper released a comprehensive plan to invest $1 billion in addressing the state’s mental health/addiction crisis. The plan outlines three areas for investment – making behavioral health services more available when and where people need them; building strong systems to support people in crisis and people with complex needs; and enabling better health access and outcomes with data and technology. Woven throughout are elements to support the behavioral health workforce. Investments detailed in the plan would raise Medicaid reimbursement rates for behavioral health services; improve access to routine, integrated care in communities and schools; address the intersection of the behavioral health and justice systems; build a strong statewide behavioral health crisis system (including housing supports, mobile crisis teams and drop-in clinics); transform child welfare and family wellbeing; create sustainable hospitalization and step-down options; and enable better health access and outcomes with data and technology.

Source: Governor Cooper Releases Roadmap for $1 Billion in Behavioral Health and Resilience Investments (NC Governor Roy Cooper)

LAPPA releases model law on protecting pregnant and postpartum individuals with SUD

The Legislative Analysis and Public Policy Association released the Model Substance Use During Pregnancy and Family Care Plans Act, which provides certain protections to pregnant or postpartum individuals with substance use disorder (SUD) so they are not penalized for receiving medical treatment, including medication to treat the SUD. The measure establishes that an infant born affected by parental SUD or showing signs of withdrawal is not, by itself, grounds for submitting a report of child abuse or neglect.

Source: Model Substance Use During Pregnancy and Family Care Plans Act (Legislative Analysis and Public Policy Association)

UnitedHealth beneficiaries seek rehearing of Wit case

UnitedHealth Group beneficiaries filed a petition asking a federal appeals court to hold an en banc rehearing of the Wit case to reconsider the ruling limiting the insurer’s obligation to cover mental health treatment. In 2020, a judge issued a sweeping ruling in favor of the plaintiffs, ordering UnitedHealth to reprocess more than 50,000 claims. Last March, a three-judge panel reversed the entire ruling, and the plaintiffs sought a rehearing. In January, while the rehearing petition was pending, the panel of its own accord vacated its order and issued a new one that sided with the plaintiffs on some legal issues. However, the new order still gave little practical benefit for plaintiffs, saying the district court could not order claims to be reprocessed for the class and that UnitedHealth was still entitled to use its own medical necessity guidelines. In the renewed petition for rehearing, plaintiffs said the court should find that UnitedHealth must follow generally accepted standards for deciding medical necessity.

Source: UnitedHealth beneficiaries seek to revive case over mental health coverage (Reuters)

Mortality of children and adolescents increasing due to injuries, including suicides and overdoses

After years of decline, between 2019 and 2020, the all-cause mortality rate for children ages 1-19 increased by 10.7%, and it increased by an additional 8.3% between 2020 and 2021. Although most of the upsurge was attributable to deaths among older children (10-19), mortality in younger children (1-9) also increased in 2021. The reversal in the pediatric mortality trajectory was caused not by COVID, but by injuries. The increase in pediatric injury deaths predates COVID, with suicides among those 10-19 beginning to increase in 2007 and homicides in 2013. Between those years and 2019, suicide mortality rates increased by 69.5% and homicide rates by 32.7%. Likely contributors include increased access to firearms and a deepening mental health crisis. Access to opioids also increased, and overdose death rates for individuals 10-19 began increasing shortly before COVID. Overdose deaths for those 10-19 rose by 113.5% between 2019 and 2020. The pandemic did not initiate these trends but may have exacerbated them.

Source: The New Crisis of Increasing All-Cause Mortality in US Children and Adolescents (JAMA)