Opioid illustration The NBGHhas made addressing the opioid crisis a top priority for this yearand beyond. (Image: Shutterstock)

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With the U.S. Senate's 99-1 passage of a comprehensive opioid reform bill, the stage isnow set for Congress to hammer out a final law that reflects bothHouse and Senate versions.

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Congress has been praised for its nonpartisan support to addressthe opioid crisis. Congress earmarked $4.7 billionto fight the crisis in its omnibus budget bill approved in March,and is expected to ante up another $3.7 billion for the upcomingfiscal year.

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Related: The best way for employers to help end the opioidcrisis

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The National Business Group on Health has long been among theleaders in pushing the federal government to address the crisis more boldly. Following theSenate vote, BenefitsPro discussed the issue with Tiffany McCaslin,NBGH's senior public policy analyst.

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Tiffany McCaslin, NBGHsenior
public policy analyst

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A veteran of the pharmaceutical industry, McCaslin has been withNBGH for three years, helping to shape its policies forpharmaceuticals and, in particular, opioids. A recent NBGH surveyrevealed a high level of concern among its employer members foraddressing the crisis, and NBGH has made addressing the crisis atop priority for this year and beyond. McCaslin discussed thegovernment's response to stemming the crisis, and the work thatremains to be done to truly reverse the tide of opioid addictionand related deaths.

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BenefitsPro: In general, what is the businesscommunity's take on Congress's response to the crisis?

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McCaslin: We are encouraged by the willingnessof Congress to come together on this important issue. The biggestobstacle to Congressional action on the opioid epidemic has beenthe funding piece. This legislation makes ameaningful commitment to funding solutions, but many experts haveobserved that a substantially larger commitment needs to be made toadvancing treatment for opioid abuse disorder. We also know thatwhile government funding and government leadership is critical toaddressing the crisis, a united effort by governments, the healthcare industry, employers and communities is needed to combatit.

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BenefitsPro: How far short do you think that fundingis?

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McCaslin: It's difficult to give a specificnumber, but some experts have suggested it could be in the tens ofbillions. The House and Senate bills focus on increasing theavailability of access to treatment. But that's just one part ofthe solution. We need to develop standards of care for thetreatment of opioid addiction. We need to increase the availabilityof eligible providers and facilities. Employers are acutely focusedon this issue, including as related to building plan designs andnetworks that will help employees receive needed treatment.

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However, they often receive feedback that adequate resources arenot available. This is particularly true for those residing inrural communities. To that extent, the appropriations process willbe critical in how solutions are implemented. Further, as thelegislation moves through conference, we urge Congress to keep outan earlier House provision, which was not included in the Senatedraft, that would have changed Medicare coverage rules forend-stage renal disease (ESRD) patients. The provision is unrelatedto opioid abuse and simply shifts costs to employer-provided healthplans.

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BenefitsPro: The crisis has been at the top of the newsfor three or four years now. There must be a list somewhere ofapproved treatment facilities, and a set of best practices foropioid addiction treatment models.

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McCaslin: Unfortunately, we really don't have alist of effective models or centers for treatment. There is nowidely accepted standard of evidence-based practices for treatingopioid addiction. We are encouraged by the volume of work beingdone in this space, including by many stakeholders across the payerand patient communities, as well as within the medical community.We understand this is a space that is still evolving. Further,given the need for more specialists to treat in this field, we arealso aware that many providers are practicing outside of theirexpertise in an effort to provided needed treatment services. Withthat in mind, standards of care are even more criticallyimportant.

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BenefitsPro: Where are the largest gaps in our currentunderstanding about how to treat this addiction?

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McCaslin: Through our engagement with expertsin this field, we have learned that the biggest gap is inunderstanding what makes an effective treatment protocol orfacility. Although there are standards related to medicationassisted therapy, there remains a lot of opportunity to furtherstandardize care. Our partnership with the American Society ofAddiction Medicine earlier this year revealed that, often, there isan attempt to adapt an effective model from addiction to addiction.But it's not that simple – there isn't a “one-size-fits-all”solution. That's where we are struggling from a plan designperspective. Coverage decisions are made based on medicallyendorsed and evidence based best practices. Absent those bestpractices, the potential exists for patients to receive the wrongtreatment at a time when they may critically need it.

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BenefitsPro: What is NBGH doing to address thisgap?

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McCaslin: We have been in contact with the[U.S.] Surgeon General's office and are encouraged by their effortsto develop those best practices. Organizationally, we are alsoworking to expand our outreach to experts and stakeholders in thisfield, to better understand and flag additional opportunities foremployers to improve access to quality treatment. Finally, we arelearning all we can from our members about their experiences withthe health care system, as related to treatment for opioidaddiction. Clearly understanding the deficiencies is the best wayto craft solutions.

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BenefitsPro: Within the organization, what are some ofyour priorities for fighting addiction at work?

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McCaslin: We have a number of initiativesunderway to address our members' concerns. From a preventativestandpoint, we are working with employers to rethink how pain, andchronic pain in particular, is treated. We have developed memberresources on both non-opioid and non-pharmacological alternatives to pain management.

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This year, we are also conducting an opioid summit: “Opioids onthe Job: A Multi-part Series on Addressing a Crisis in the AmericanWorkforce,” which is a multi-part series aimed at addressing amultitude of employer questions and challenges on opioid relatedtopics, some of which include: stigma, patient self-advocacy (i.e.,requesting non-opioid pain management), and understanding how thereimbursement system can be modified to recognize the value ofprovider consult needed to rethink the tendency to prescribe anopioid when a an alternative may be more appropriate.

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Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.