In the fall of 2018 the U.S. House and Senate passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the SUPPORT Act)[1] – comprehensive legislation to address the opioid epidemic. As part of this law, Medicaid programs are required to implement limits on coverage of opioids in certain cases. The American Cancer Society Cancer Action Network (ACS CAN) strongly encourages Medicaid policymakers implementing these limits to ensure that cancer patients and survivors still have access to the pain and symptom management they need.
Cancer and Ongoing Treatment for Pain
Pain is one of the most feared symptoms for cancer patients and survivors - nearly 60 percent of patients in active treatment and 30 percent of patients who have completed treatment experience pain.[2] Pain can be caused by the cancer itself, for instance when tumors interfere with normal body function. Pain can also be caused by cancer treatments and can persist for a long time after treatments have ended. For example, research has found that about one-quarter of women who have had breast cancer surgery have significant and persistent breast pain six months after the procedure.[3]
In September 2019, ACS CAN – through our Survivor Views project – surveyed cancer patients and survivors about pain and palliative care issues.[4] We found that:
New Required Medicaid Limits on Opioids
The SUPPORT Act requires Medicaid programs (including managed care plans) to have a drug review and utilization (DUR) program that implements “safety edits” – checks at the pharmacy – for opioid prescriptions that are refilled, over a certain dosage amount, or that are prescribed concurrently with certain other drugs.[7]
Medicaid programs are required to:
ACS CAN Position
ACS CAN believes that any limits on opioid prescriptions should be based on quality evidence showing that such a limit will improve health outcomes and prevent opioid misuse and abuse. The goal of limits should not simply be a reduction in opioid utilization.
Furthermore, any program limiting the amount, dosage, or number of refills for opioid prescriptions should exempt:
[1] 42 USC §1396a(oo)
[2] Institute of Medicine. (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. National Academy of Sciences.
[3] Miaskowski C, Cooper B, Paul SM, et al. (2012). Identification of Patient Subgroups and Risk Factors for Persistent Breast Pain Following Breast Cancer Surgery. J Pain; 13(12) pp 1172-1187.
[4] American Cancer Society Cancer Action Network. First Survivor Views Survey Highlights Barriers to Addressing Side Effects of Cancer Treatment. Press Release. October 28, 2019. https://www.fightcancer.org/releases/first-survivor-views-survey-highlights-barriers-addressing-side-effects-cancer-treatment
[5] American Cancer Society Cancer Action Network. Survivor Views: Pain and Palliative Care; Survey Findings Summary. October 28, 2019. https://www.fightcancer.org/sites/default/files/Survivor%20Views.Pain%20and%20Palliative%20Care%20Polling%20Memo.20191028_FINAL.pdf Additional analysis of Survivor Views data conducted by ACS CAN staff.
[6] Ibid.
[7] Centers for Medicare and Medicaid Services. State Guidance for Implementation of Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (P.L. 115-271). August 5, 2019. https://www.medicaid.gov/federal-policy-guidance/downloads/cib080519-1004.pdf
[8] Sample language used in Medicare policy that is inclusive of survivors: “patients being actively treated for cancer-related pain”. See 42 CFR §423.100, and the discussion in CMS–4182–F, available at https://www.govinfo.gov/content/pkg/FR-2018-04-16/pdf/2018-07179.pdf
