OPINION:
The opioid epidemic affects Americans of all ages, but one group is too often overlooked: seniors.
Drug overdose deaths among Americans 65 and older have nearly tripled over the past decade. In 2023 alone, 1.2 million Medicare beneficiaries had opioid use disorder and more than 53,000 experienced an overdose.
As a spine surgeon dual board-certified in orthopedic surgery and addiction medicine, I see the intersection of pain and dependency every day. My goal after surgery is not just effective pain management but also reducing the risk of long-term opioid dependency.
Medicare Part D is working against that goal.
Today, opioids are often the cheapest and easiest option on plan formularies. Safer alternatives are frequently placed on higher-cost tiers, subject to prior authorization or blocked by “step” therapy.
In practice, that means a senior must first “fail” an opioid before gaining access to a safer treatment.
We know that initial opioid exposure, especially after surgery, can lead to long-term use and addiction. Yet Medicare’s coverage policies are nudging patients toward the very drugs policymakers have spent years trying to limit.
The administration already has the authority to fix this. The Centers for Medicare & Medicaid Services can act now to better align Medicare with modern, opioid-sparing standards of care.
It can require Part D plans to provide timely coverage of Food and Drug Administration-approved, non-opioid therapies, curbing step therapy policies that force patients onto opioids first and promoting formularies that reflect current clinical practice.
When CMS extended Medicare reimbursement to more qualifying non-opioid treatments under the NOPAIN Act on March 27, it demonstrated exactly that authority in action. When the Alternatives to PAIN Act drew bipartisan support at a House hearing the day before, it showed that Congress is ready to move.
Yet neither development has changed what seniors pay at the pharmacy counter under Part D.
Passing the Alternatives to PAIN Act would deliver that fix, requiring Part D plans to waive deductibles for qualifying non-opioid treatments, place them on the lowest cost-sharing tier and prohibit prior authorization and step therapy.
In short, it would put non-opioid therapies on equal footing with opioids.
Some critics argue that these alternatives are more expensive than generic opioids. That may be true upfront, but it ignores the far greater downstream costs.
ADAM BRUGGEMAN
Chairman, IndeMed
San Antonio, Texas
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