There is a constant drum beat around the rising cost of drug prices, with little discussion of the benefit design in plans whether they are government or employer sponsored. Medicare Part B requires patients without supplemental coverage to pay a 20% copay on all charges with no maximum out of pocket cost threshold.

Many members of the Patients Rising community need pain relief therapies in their care plan. Several patients have had to jump through hoops to get the doses their doctors are prescribing for their pain management needs. It is clear to everyone we need alternatives to opioid treatments. However we must promote the innovation of those treatments and promote programs that will help secure their access.

Patients Rising Now supports the bipartisan regulatory push to waive the 20% copay in Medicare Part B for non-opioid pain management drugs. At this time, there is only one of these medications in Medicare Part B, which is why we are including the exact name of the medication being discussed.

We will be commenting to CMS on this.  If pain management for you or a loved one is an issue you care about — we encourage you to write your own letter by clicking here.

Comment Solicitation on Policy Modifications for Non-Opioid Pain Management Drugs

The Centers for Medicare and Medicaid Services (CMS) is soliciting input from stakeholders on barriers to access to non-opioid pain management drugs. It also is seeking feedback on the extent to which Medicare policies under the Hospital Outpatient Prospective Payment System (OPPS) or Ambulatory Surgical Center (ASC) Payment System could be modified to address those barriers. This comment solicitation is included in the Medicare Program Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs Proposed Rule for Calendar Year 2022.[1]

Opportunity to Provide Feedback on Access Barriers to Non-opioid Intrathecal Pain Management Treatment

 The comment solicitation is an opportunity for interested third-party stakeholders to provide their perspective on, among other things:

  • The current barriers Medicare beneficiaries and their treating providers face in seeking access to PRIALT® (ziconotide) solution[2], including the ways in which the 20% patient out-of-pocket coinsurance for treatment with PRIALT may create a financial barrier for patients seeking access to a non-opioid intrathecal treatment.
  • The reasons why beneficiaries eligible for intrathecal pain management for severe chronic pain should have access to PRIALT, as the only non-opioid drug approved by the Food and Drug Administration (FDA) for severe chronic pain in patients for whom intrathecal therapy is warranted and who are intolerant or refractory to other treatments.
  • The ways in which waiving the coinsurance for non-opioid pain management drugs that are: (1) FDA-approved and indicated for intrathecal analgesia in adults with severe chronic pain; and (2) separately payable under the OPPS, is a narrow solution that will ameliorate barriers for beneficiaries for whom this treatment is appropriate, while also serving the public health goals of Medicare. These are patients who are intolerant of or refractory to other treatments such as systemic analgesics.