Reform Medicare’s Payment Policy to Expand Patient Access to Nonopioids


That’s how many friends and loved ones have died from a drug overdose in the 12 month period leading up to October 2021—an all-time record. Millions more—40.3 million to be exact—are living with a substance use disorder, including opioid use disorder, putting them at serious risk of adding to this grim tally.

Saving lives will require an all-hands-on-deck approach. In his State of the Union address, President Joe Biden highlighted the country’s desperate need to end the opioid epidemic and invest more in efforts to prevent addiction and overdose.

As an advocate for patients across the country, I couldn’t agree more. Although our nation is working to address this crisis, stopping opioid overprescription—and expanding patient choice to safe alternatives—must be part of the conversation.

While opioid-based painkillers are important and clinically necessary for many patients, they should rarely be the first approach for managing pain. Yet, that is exactly how many well-meaning health providers have acted for years.

As our nation’s health care system emphasized pain as the sixth vital sign, and as physicians were told that powerful new painkillers were not addictive, more and more opioids were prescribed to patients. This fueled the crisis we find ourselves in. By 2012, more than 255 million opioid prescriptions were written, enough to give one to more than 80% of all Americans.

While we’ve made great strides to reduce overprescription, nearly 4% of American counties still dispense enough opioids so that every man, woman, and child could have one. The average surgical patient receives 80 pills, about half of which go unused. Over 9 million Americans misused prescription pain relievers in 2021—some of which were prescribed in their name, others which were diverted from patients with legitimate needs.

Too often, opioid-based painkillers serve as a “gateway” to addiction and stronger, deadlier drugs. According to the National Institute on Drug Abuse, approximately three-quarters of heroin users reported using prescription opioids prior to initiating heroin use.

All this means is that we are still facing a major problem. Safe, effective nonopioid alternatives for treating acute pain are plentiful, including sympathetic nerve blocks, nonsteroidal anti-inflammatory drugs (NSAIDs), long-acting local anesthetics, physical therapy, and massage therapy, just to name a few. When prescribed appropriately, such approaches can significantly reduce pain scores, improve patient outcomes, and decrease opioid utilization.

Yet, too many patients are still prescribed opioid-based painkillers by default. Why? Because Medicare’s payment policy continues to incentivize the use of opioids, including fentanyl, over a wide variety of nonopioid drugs and devices. By fully covering the cost of opioids for acute pain, but requiring physicians to pay for nonopioid alternatives, it is little wonder why the opioid prescription rate is so high during and after surgery.

To reduce unnecessary exposure to opioids, and to enhance patient choice over their own care, it is critical to level the playing field so that no single treatment approach is favored over another.

Luckily, Congress thinks so too. A bipartisan coalition of lawmakers are championing the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act. If passed into law, the bill would modernize Medicare’s payment policy to remove the structural barriers that disincentivize physicians from utilizing nonopioid approaches to manage the pain associated with surgery in outpatient settings.

As a result, the NOPAIN Act would expand patient access to nonopioid drugs, devices, and therapies that have been approved by the FDA. Importantly, the legislation would not prevent or disincentivize doctors from prescribing opioids when they believe it is appropriate for patient care, thus establishing a fair balance for all patients.

Ultimately, addressing the opioid crisis will require a strong, multifaceted approach that includes efforts to prevent addiction before it begins. By passing the NOPAIN Act, Congress can seize the win-win opportunity to reduce unnecessary exposure to opioids, while protecting—and expanding—a patient’s right to choose their own care.

By Percy