Policy News Roundup: July 11, 2024

Key reads

Supreme Court rejects Purdue settlement

The Supreme Court rejected the Purdue opioid settlement plan that would have provided $6 billion to states, localities and victims of the opioid crisis. In a 5-to-4 decision, a majority held that the federal bankruptcy code does not allow liability shields for third parties in bankruptcy agreements (i.e., members of the Sackler family cannot be protected from future lawsuits because they did not file for bankruptcy, only Purdue did). In the dissenting opinion, justices argued that the decision will be devastating for the opioid victims and their families. Advocates and families of those who have died from opioids are split, with some wanting the settlement to be upheld so that the money for families and opioid abatement can go out quickly, and others not wanting to give a pass to the Sacklers via the liability shield. Purdue and the Sacklers said they will continue working with creditors to reach a resolution. Several states and local governments have also said they are eager to resume settlement talks. The alternative to a settlement is thousands of lawsuits filed across the country, a costly and difficult process that would likely eat up potential payouts. But it is not clear if or how a settlement could be reached, given the Sacklers’s resistance to any agreement without the liability shield.

Source: Supreme Court Rejects Liability Shield at Center of Purdue Pharma Settlement (The New York Times); Purdue Opioid Settlement on Verge of Collapse After Supreme Court Ruling (New York Times); The Supreme Court rejects a nationwide opioid settlement with OxyContin maker Purdue Pharma (Associated Press)

NIDA stresses need for addiction treatment in jails and prisons

National Institute on Drug Abuse’s (NIDA) Nora Volkow and Tisha Wiley explain the need to provide addiction treatment in jails/prisons. A high percentage of people who are incarcerated have a substance use disorder, and they are at high risk of overdose upon release. The belief that simply stopping someone from using substances while in jail/prison is an effective approach to treatment is inaccurate and dangerous. Medications for opioid use disorder (MOUD) are effective, safe and lifesaving but underused, particularly in criminal justice settings. Programs across the country offer naloxone and MOUD in jails/prisons, paired with instruction, training and social support. Federal agencies have launched programs to help people manage withdrawal in jails and provide financial health care support for people reentering the community. Revised methadone rules allow jails/prisons registered as hospitals or clinics to dispense MOUD. NIDA funds partnerships to figure out how to link people with addiction to care during and after time in corrections systems. A dangerous supply of illicit drugs, fragmented treatment systems, lack of funding, lack of training, stigma and complex logistics all work against people with substance use disorders as they rebuild their lives after incarceration, and support in recovery and continuity of care are essential.

Source: Everyone deserves addiction treatment that works — including those in jail (STAT)

Supreme Court upholds ban on sleeping outdoors

The Supreme Court upheld an Oregon city’s laws aimed at banning residents experiencing homelessness from sleeping outdoors, a decision that will likely alter how Western states police homelessness. The 6-to-3 ruling split along ideological lines. The conservatives suggested the matter was an issue best solved by lawmakers, cities and states, while the liberal justices argued homelessness is protected by the Constitution. Justice Gorsuch, writing for the majority, said that the laws did not violate the Constitution’s prohibition on cruel and unusual punishment. Justice Sotomayor, in the dissenting opinion, said the decision would leave society’s most vulnerable with few protections and that the laws punish people for being homeless. She said it is “unconscionable and unconstitutional.” Politicians and many residents have grown frustrated with the growing, increasingly visible and overlapping mental health, substance use and homelessness crises.

Source: Supreme Court Upholds Ban on Sleeping Outdoors in Homelessness Case (The New York Times)

Supreme Court decision threatens health care rules

The Supreme Court reduced the authority of federal agencies, which could upend regulations in countless areas, including health care. In a 6-to-3 ruling, divided along ideological lines, the court overturned the longstanding precedent of the Chevron doctrine, which required courts to defer to the expertise of federal agencies in carrying out laws passed by Congress. The conservative legal movement and business groups have long objected to Chevron, due in part to general hostility to government regulation and the belief, based in separation of powers, that agencies should have only the power that Congress has explicitly given them. Supporters of the doctrine say it allows specialized agencies to fill gaps in ambiguous statutes to establish uniform rules in their areas of expertise. Chevron’s demise could threaten regulations on everything from drug prices to insurance coverage to pandemic mitigation. Medicare, Medicaid, the Food and Drug Administration, the National Institutes of Health, hospitals and insurers operate under thousands of federal regulations that have shaped the modern health care system. The decision is expected to result in a flood of new litigation challenging a variety of health care rules.

Source: Justices Limit Power of Federal Agencies, Imperiling an Array of Regulations (The New York Times); How the Supreme Court’s Chevron decision could affect health care (Politico)

Court upholds ACA preventive services, but challenge is ongoing

The 5th Circuit Court of Appeals issued a decision in a case challenging the Affordable Care Act’s (ACA) requirement for employer health plans to cover no-cost preventive care. Those challenging the mandate argue that because the U.S. Preventive Services Task Force (USPSTF) is made up of outside experts who are not Senate-confirmed, their recommendations of which services must be covered under that mandate cannot be enforced. They also claim that the requirement for insurance to cover PrEP for HIV violates their religious rights. Services currently requiring coverage include many screenings for mental health, substance use and related conditions. The court ruled that USPSTF members are not “validly appointed,” but that it was an “error” for the lower court to prohibit the mandate nationwide. The court ruled that Braidwood Management, the Texas-based company that objected to the mandate, could not be forced to provide its workers with insurance that covers the preventive services. But the court reversed a lower court ruling that would have blocked the mandate nationwide, protecting most access to preventive services. The case now returns to the Texas district court where Judge Reed O’Connor, who has ruled several times against the ACA, will hear arguments on whether the USPSTF has the power to decide what insurers must cover.

Source: Obamacare mandate survives at 5th Circuit, but challenge continues (Politico); Court upholds ACA’s free preventive services mandate (Axios)

Parity rules at White House for review

Final regulations to strengthen parity enforcement have reached the White House for review, signaling that they could be coming soon. The proposed regulations would force compliance and impose fines if necessary. They would expand requirements under the Mental Health Parity and Addiction Equity Act and mandate that insurers analyze their coverage to ensure equivalent access to mental health care based on outcomes. The administration has said insurers have failed to comply with parity regulations. Insurers have slammed the proposal, saying that workforce shortages are a major obstacle and that the proposal is unworkable.

Source: Mental health parity rules now under White House review (Politico)

CMS approves 5 states to provide care for those leaving incarceration

The Centers for Medicare and Medicaid Services approved demonstrations that will allow Illinois, Kentucky, Oregon, Utah and Vermont to provide Medicaid/CHIP coverage to individuals before release from incarceration, creating a more seamless transition and avoiding gaps in coverage. These states join California, Massachusetts, Montana and Washington in pursuing the option. The Medicaid Reentry 1115 Demonstration Opportunity allows a state to cover certain services not otherwise coverable in Medicaid/CHIP up to 90 days before an eligible person’s expected release from incarceration. This includes coverage of addiction treatment before a beneficiary is released from jail, prison or a youth correctional facility. States will be able to help connect people to community-based providers up to 90 days prior to their release.

Source: HHS Authorizes Five States to Provide Historic Health Care Coverage for People Transitioning out of Incarceration (Department of Health and Human Services)

Rite Aid settles with DOJ over opioid claims

Rite Aid and 10 subsidiaries and affiliates have agreed to settle with the Department of Justice over allegations under the False Claims Act and Controlled Substances Act. Under the settlement, the government will be paid $7.5 million and have a claim of $401.8 million in Rite Aid’s bankruptcy case. The complaint alleges that Rite Aid knowingly dispensed hundreds of thousands of unlawful prescriptions for controlled substances despite clear “red flags.” A memorandum of understanding with the Drug Enforcement Administration (DEA) would require employees to receive additional training to help them identify illegitimate prescriptions, require Rite Aid to create and keep materials relevant to DEA investigations for at least five years and commit Rite Aid to implementing and managing an anonymous hotline for employees, patients and the public to report suspected illegal dispensing.

Source: Rite Aid Corporation and Affiliates Agree to Settle False Claims Act and Controlled Substance Act Allegations Related to Opioid Dispensing (Department of Justice)

CDC study shows gaps in OUD treatment

A Centers for Disease Control and Prevention study found that in 2022, 3.7% of U.S. adults 18+ needed opioid use disorder (OUD) treatment. Among these, only 25.1% received medications for OUD (MOUD). Most adults who needed OUD treatment did not perceive they needed it (42.7%) or received OUD treatment without MOUD (30%). Higher percentages of White adults than Black and Hispanic adults received any OUD treatment. Higher percentages of men and adults 35-49 received MOUD than women and younger/older adults. Expanded communication about the effectiveness of MOUD is needed, along with increased efforts to engage people with OUD in treatment that includes MOUD. Clinicians and other treatment providers should offer evidence-based treatment, including MOUD, and pharmacists and payors can work to make MOUD available without delays. Federal leaders released a commentary providing recommendations for clinicians to achieve a care cascade for OUD — widespread screening regardless of the point of care, ensuring diagnosed patients receive treatment including medications, and retaining patients in care.

Source: Treatment for Opioid Use Disorder: Population Estimates — United States, 2022 (Centers for Disease Control and Prevention)

Massachusetts towns adopting "nicotine-free generation" laws

Last month, the board of health in Reading, Massachusetts, adopted a regulation to create a “nicotine-free generation,” preventing anyone born in 2004 or later from buying cigarettes or nicotine products when they turn 21. Five other communities in Massachusetts have taken the same step in recent months, building on the example set by Brookline in 2020. At least two other cities in the state are considering similar measures. That the push found traction in Massachusetts is perhaps unsurprising. In 2005, Needham became the first place in the country to raise the legal age to purchase tobacco products to 21. Years later, the rule began to spread within the state and was ultimately enacted nationwide during the Trump administration. Brookline is the only place in the world where a tobacco-free generation policy is in force, though other Massachusetts city rules are set to take effect January 1.

Source: Some Massachusetts towns are trying to say goodbye to tobacco — forever (The Washington Post)

Study finds most are unaware PCPs treat addiction

A study found that most people do not know primary care providers (PCP) can treat opioid use disorder (OUD). The study found 61.4% of respondents did not know a PCP could treat people with OUD by prescribing medications for OUD (MOUD), and 13.3% incorrectly believed a PCP could not. Nearly 80% agreed that a PCP office should be a place where people can receive OUD treatment. Among those who reported ever intentionally misusing opioids, most said they would be comfortable seeking MOUD from their PCP. Of those with no history of intentional opioid misuse, most said they would be comfortable referring someone they care about to their PCP for MOUD. Black respondents were most likely to believe they could not receive MOUD at a PCP. Raising awareness that PCPs can provide MOUD is critical. Interventions could include messaging campaigns similar to those for HIV testing and cancer screening. Literature and signage about MOUD could be placed in waiting areas and exam rooms. PCPs could proactively screen patients for OUD and offer to prescribe MOUD as indicated.

Source: Most Americans don’t know that primary care physicians can prescribe addiction treatment (National Institute on Drug Abuse)