The Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (S 3067) would amend section 1833(t) of the Social Security Act to create financial incentives for administering non-opioid pain treatments, instead of opioids, following outpatient surgical procedures.
Currently, the Centers for Medicare and Medicaid (CMS) issues bundled payments that cover all the supplies and medications used for surgeries that do not require hospitalization, for instance, those performed at a provider’s office or at ambulatory surgical centers (ASCs). In other words, providers receive the same, fixed financial assistance from CMS for a given type of outpatient surgery based on its average national cost, no matter what pain management strategy is used following the procedure. As such, providers might be incentivized to administer opioids after surgery, if they are the cheapest option, to reduce costs.
To reduce the incentive for administering opioids for pain management, the NOPAIN Act would direct CMS to make a separate payment to finance non-opioid pain treatment used after surgical operations in outpatient settings. With this new reimbursement pathway, employing non-opioid pain management strategies after outpatient surgeries would become more cost-effective than administering opioids. Treatments eligible for such separate payments under the NOPAIN Act would include any approved pharmaceutical, biologic, or medical device clinically demonstrated to be as effective as opioids in managing pain.
In addition, this bill would direct the US Department of Health and Human Services (HHS), in collaboration with CMS, to report on persistent gaps in the availability and accessibility of the alternative pain management therapies (e.g., cognitive behavioral therapy or therapeutic exercise) highlighted in the Pain Management Best Practices Inter-Agency Task Force’s final report. Accordingly, the bill would call upon HHS to recommend strategies for expanding Medicare coverage and reimbursement of such services and removing barriers to access for patients.
The NOPAIN Act builds upon provisions in the SUPPORT for Patients and Communities Act (PL 115-271), which requires CMS to evaluate whether reimbursing outpatient opioid and non-opioid treatments separately would allow providers to shift away from preferentially administering opioids. A subsequent report to Congress by the Medicare Payment Advisory Commission affirmed that hospitals may have incentives to opt for cost-effective medication options in outpatient settings, but also stated that the listed price ranges for opioid and non-opioid pain management modalities largely overlap. However, the report also acknowledged that the net costs associated with an individual hospital’s purchase of medicine is often not known, conceding that it would be difficult to identify systematic price disparities between opioids and non-opioids in a hospital setting.