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Senate Has the Power to Expand Access to Medication for Opioid Addiction

August 21, 2018
BIO President and CEO Jim Greenwood posted the following op-ed on Linked-In today, making the case for the U.S. Senate to act on legislation that would empower the Centers for Medicaid and Medicare Services to broaden coverage of medication-assisted treatment to help Americans in the throes of opioid addiction.

How serious is our national opioid emergency? More than 115 Americans die every day from an opioid overdose. By contrast, 44 people in this country died a day during the peak of the devastating AIDS crisis.

Decades ago, we saw how effective the HIV/AIDS community was in asserting its political power to demand a government solution to that tragedy. Investment into breakthrough antiretroviral treatments – and public-private collaborations to make these drugs accessible – transformed a lethal epidemic into a manageable, chronic condition.  Now, three decades later, government and industry must work together once again to end a public health cataclysm.

Opioid addiction fundamentally alters a person’s brain chemistry, producing potent cravings and horrible withdrawal symptoms for those trying to stop using. But thanks to biotech breakthroughs made possible by our deepening understanding of neuroscience, medications already approved by the U.S. Food and Drug Administration can reduce opioid cravings, dampen euphoric side effects and diminish withdrawal symptoms.

Biotechnology companies have developed and continue to work on improved medication-assisted treatments to improve the quality of care and long-term recovery for patients suffering from this terrible disease.  Like almost everyone in America, I have a member of my extended family afflicted with this disease. After years of witnessing the struggles of someone I care about deeply, we finally convinced her to take Vivitrol before leaving prison, which we believe will provide her with the best chance to finally conquer her addiction. This breakthrough medication acts as an antagonist to block receptors in the brain so they can’t be activated by opioids. It’s an example of how the power of innovation can improve the lives of patients suffering from addiction.

Research shows that medication-assisted treatment (MAT) – where medicine such as buprenorphine, methadone and Vivitrol is administered alongside cognitive or behavioral care – is the most successful way to facilitate long-term recovery. Administered properly, MAT decreases overdose deaths, criminal activity and infectious disease transmission, according to the National Institute on Drug Abuse, while increasing patient retention in therapy programs.

The problem is, the pathway to receive MAT is not always clear, with a patchwork system of varying coverage levels across different states and insurance carriers. Even when payers will pay, most rehab facilities still do not offer MAT. Research suggests that only one in three people enrolled in privately funded specialty treatment programs receives medication-assisted treatment for opioid dependence.

So the Biotechnology Innovation Organization (BIO) decided to go talk to Americans in recovery programs to get their perspective. We recently took a group of biotech leaders to Ohio, where one in five fatal opioid overdoses occurs. We brought together scientists working on pain and addiction therapies with patients suffering from opioid addiction for a candid conversation.

We met a 30-something who got lost so deep into her addiction that foster care took her daughter away. Then, she got pregnant again. She managed to stay off opioids for the last three months of her pregnancy to give birth to a healthy baby. But three minutes after her child was born, she was back on them. That’s how addiction takes your soul.

We met with folks at different stages of recovery who could easily be anyone’s friend or neighbor. These were good people wrestling with powerful chemical dependency. The statistics show that the vast majority will relapse. Even those clean for years told us the monster never leaves their brain. They said that once they succumb and start to use again, they don’t care about their families, jobs or reputations. They care only about getting that drug back into their system. That’s why MAT is so important, because it can help their resolve to overpower their cravings.

Of course, the ultimate solution lies in stopping addiction before it starts. That means innovating more non-addictive painkillers for people living with severe and chronic pain. One in three Americans – roughly 100 million people – report suffering from some type of pain, according to the National Academy of Science’s Institute of Medicine. That’s more people than suffer from diabetes, cancer and heart disease combined.

There are non-opioid analgesics on the market for certain painful conditions, but too many insurers are pushing beneficiaries to cheaper alternatives. They’re effectively saying, “First, go ahead and try a generic opioid. If you fail on that, maybe we’ll cover a different approach.” This utilization management practice hooks more people.

It’s in the interest of insurers to step up to the plate and be part of the solution. Otherwise, they’ll end up paying for rehabilitation, hospitalization and all kinds of health problems that will be more expensive in the long run.

We need to cover existing treatments and invest in new ones. There are 125 new painkillers being tested in clinical trials, 87 percent of which are non-opioids. But compare that to a pipeline of 1,700 novel cancer programs, a disease area that receives 17 times more venture capital than novel pain meds. Meanwhile, R&D investment for new addiction medications is virtually non-existent. Why? If insurance won’t pay, investors won’t invest, innovation stalls and American families wrestling with opioid dependency ultimately pay the price.

About four in 10 of the more than 2 million Americans with opioid addiction are covered by state Medicaid programs. This makes the Centers for Medicare & Medicaid Services (CMS) a pivotal agency in addressing this crisis.

This summer, the U.S. House of Representatives passed comprehensive legislation to address the opioid crisis by a vote of 396-14.  The House bill directs CMS to create an Opioid Action Plan that can help ensure medication-assisted treatment is not placed on expensive specialty tiers or priced at levels where high patient out-of-pocket costs preclude access. The bill would encourage CMS to work with state Medicaid programs in using waivers to cover holistic addiction treatment. Finally, it would empower CMS to educate treatment providers about the latest research on the efficacy of innovative treatment options.

A similar proposal is supported in the Senate by Senators Dean Heller (R-NV) and Bob Menendez (D-NJ) to authorize the CMS Opioid Action Plan.  This is a crucial piece of the puzzle that should be included in any Senate package if we’re serious about helping Americans get off and stay off these drugs.

Overdose deaths from prescription painkillers, fentanyl and heroin have quadrupled in the last 15 years. Every 20 minutes, another American dies from an opioid overdose. The urgency of Senate action this year cannot be overstated. The only long-term solution is to innovate our way out of the opioid crisis – and work together to ensure patient access to the breakthroughs that scientists discover. We did it during the AIDS epidemic, and we can and must do it again.