On Jan. 14, then-Assistant Secretary for Health Brett Giroir, MD, announced that HHS would be taking action to expand access to buprenorphine for the treatment of opioid use disorder (OUD) by removing the special training requirements and regulations associated with these prescriptions.
Under current law, physicians are required to obtain a special waiver that involves taking an eight-hour training course, maintaining special records of their patients being treated with buprenorphine and being subject to Drug Enforcement Administration (DEA) audits. These requirements have consistently posed a barrier to patients receiving buprenorphine for the treatment of OUD, even as the nationwide epidemic of drug-related overdose deaths has accelerated.
If implemented, the practice guidelines would allow all physicians who are registered with the DEA to prescribe buprenorphine for patients with OUD. Physicians utilizing the new authority would be limited to prescribing buprenorphine for up to 30 patients, with exceptions for emergency physicians and certain other hospital-based physicians. In a statement, AMA Immediate Past President and Opioid Task Force chair Patrice A. Harris, MD, MA, strongly endorsed the new HHS policy as it can help reduce the wide gap between the number of patients who need treatment for OUD and the number who are receiving it, with the potential to save many patients’ lives.
After policies issued in the final weeks of the previous administration were placed under review by the new administration, the AMA joined the American College of Emergency Physicians and other organizations in a Jan. 27 letter to the Acting Secretary of HHS (PDF), with copies to the acting head of DEA and the Office of National Drug Control Policy (ONDCP), urging them to strive to eliminate the barriers to physicians prescribing this vital treatment as soon as possible. Also on Jan. 27, ONDCP issued an official statement indicating that the new practice guidelines are not being implemented at this time, but that it and HHS are committed to working with interagency partners to examine ways to increase access to buprenorphine, reduce overdose rates and save lives.
Despite the potential for a policy change soon that would remove the eight-hour training requirement to prescribe buprenorphine for treatment of OUD, it is important for physicians to become educated in how to screen their patients for substance use disorders and either treat them or refer them for treatment. The AMA’s microsite at End the Overdose Epidemic offers numerous educational resources for physicians on this topic.
On Jan. 28, the AMA submitted comments (PDF) in response to a Centers for Medicare & Medicaid Services (CMS) Interim Final Rule with comment strongly urging the agency to continue separate payment for audio-only services in the future and to implement and pay for CPT code 99072 to recognize the increased expenses due to infection control practices necessary to safely immunize and care for patients during the COVID-19 public health emergency (PHE). Payment for audio-only visits has been a lifeline for patients during the COVID-19 PHE, and the need for these services to be available will not diminish when the PHE ends. Access to audio-only services is critical for patients who do not have access to audio-video telehealth services. Discontinuing payment for these services would exacerbate inequities in health care, particularly for those who lack access to audio-video capable devices such as seniors in marginalized and minoritized communities that have been devastated by COVID-19.
In addition, the AMA expressed disappointment that CMS adopted an interim final policy to implement CPT code 99072 as a bundled service as many services do not include these specific personal protective equipment (PPE) items and physician practices are facing increased PPE and infection control expenses. The AMA reiterated its recommendation that CMS implement and pay separately for CPT code 99072 with no patient cost-sharing, which it believes will support the Administration’s goal to mount a safe, effective and comprehensive vaccination campaign–a goal strongly supported by the AMA. Separate payment for these increased expenses is also essential to protect the viability of our nation’s health care workforce and to alleviate the financial strain that physicians face.