The White House budget request for fiscal 2017 being unveiled Tuesday will include $1.1 billion to combat opioid abuse, with a focus on medication-assisted treatment.
The bulk of the money would fund state programs in an effort to make treatment more available and easier to afford. States with higher rates of opioid abuse and strong plans for addressing it will get more funding.
Another effort will be $50 million to help about 700 new doctors provide medication-assisted treatment and other treatments, particularly where there is a shortage of behavioral health providers. The request includes $30 million to study the effectiveness of medication-assisted treatment.
Dan Mendelson, president of Avalere Health, said improving treatment for opioid abuse disorders is one of few truly bipartisan health issues in the budget this year. Presidential candidates have integrated the topic into their stump speeches in response to frequent questions from the public.
“This issue is starting to appeal to voters because they all know somebody who has been affected by it,” he said.
The administration wants specific proposals to focus on, and medication-assisted treatment is effective and supported by many health experts, he said.
The White House is also asking for $500 million to build state-level programs, particularly in rural areas, and increase access to buprenorphine, which treats opioid addiction. It would create a pilot program to allow physician assistants and nurse practitioners in some areas to prescribe the drug, which currently has strict limits on who can prescribe it and to how many patients.
The Centers for Disease Control and Prevention is developing guidelines suggesting doctors who prescribe opioids consider alternative methods and use low doses at first. Some politicians have suggested overprescribing drives the epidemic. Physicians' groups, some of whom run pain clinics and said they tend to many patients who have a legitimate need for the painkillers, argued they were not consulted in creating the guidelines. That played a part in delaying the release of those guidelines. The CDC has not yet said when it will release them.
Bradley Stein, a senior scientist with the RAND Corp., said medication-assisted treatment is one of the most effective options for curbing opioid abuse and called its inclusion in the budget “very encouraging.”
These treatment options have improved as more medication is available. Methadone was previously the only approved treatment, and it required a daily trip to a clinic that could be many miles away, he said.
The key for legislative proposals is to increase access to treatment while maintaining its safety and effectiveness, Stein said.
“It really is a problem that has been increasingly more common and is affecting more people,” he said. “And no one is immune.”
Medication-assisted therapy has proven effective in reducing overdose deaths and improving treatment retention. But its use decreased from 2002 to 2010, partly because of the stigma that patients are merely substituting one drug for another, according to the Substance Abuse and Mental Health Services Administration.
The cost of medicine like buprenorphine, however, has been increasing rapidly as the overuse epidemic has grown and spread across the country. Treatment for prescription drug and substance abuse disorders is one of 10 mandated essential health benefits under the ACA.
Recent efforts to require treatment options that are more specific and include access to certain drugs have met resistance from insurance companies and pharmacy benefit managers, which say cost is becoming prohibitive.
The 2017 proposed budget will also call for changes to the tax on high-end health insurance plans that was included in the Affordable Care Act but has since been delayed. It will also request funding for a major cancer research initiative and also for study of the Zika virus.
Most of the money would go to health officials for such things as improving laboratory testing capacity, education and establishing rapid-response teams. About $250 million of assistance would be directed specifically to Puerto Rico though extra Medicaid funding for health services, and $200 million would go toward research and commercialization of new vaccines and diagnostic tests.
U.S. health officials say the money is critical for research into the birth defect known as microcephaly. They also want to speed development of a vaccine and better diagnostic tests, and expand mosquito control programs. Some of the money would also aid Zika-stricken countries and territories.
The request for funds to fight the Zika virus includes nearly $1.5 billion for the HHS to better monitor the virus, improvement to mosquito control programs and additional support to low-income pregnant women. It also includes funding dedicated to vaccine development.
The budget's change to the Cadillac tax would narrow its application so that fewer plans are affected, but opponents have maintained that they believe the tax needs to be repealed entirely. Another ACA-related request would extend the offer of three years of full federal coverage of Medicaid expansion to the 19 states that have so far refused expansion.