Ohio Health Policy News

The Centers for Disease Control and Prevention on Thursday softened its guidelines for U.S. doctors prescribing oxycodone and other opioid painkillers (Source: “US agency softens opioid prescribing guidelines for doctors,” Associated Press, Nov. 14).

The new CDC recommendations are an update to 2016 guidelines that added momentum to a decline in opioid painkiller prescriptions.

The previous guidance succeeded in reducing inappropriate and dangerous prescribing, some experts say. But they also were seen as a barrier to care, with some pharmacists refusing to fill prescriptions as doctors wrote them.

The new guidelines are designed to ensure that patients get compassionate and safe pain care, CDC officials said.

A draft released in February received 5,500 public comments. Some modifications were made, but several main changes stayed in place, including no longer suggesting limiting opioid treatment for acute pain to three days; dropping the specific recommendation that doctors avoid increasing dosage to a level equivalent to 90 milligrams of morphine per day; and urging doctors to not abruptly halt treatment for patients receiving higher doses of opioids unless there are indications of life-threatening danger.

A California-based Medicare Advantage plan is touting its success at improving health disparities by tying its executives’ bonuses to the issue (Source: “How one insurer tied executive performance bonus to reducing healthcare disparities,” MedCity News, July 25).

One aspect SCAN Health Plan looked at was medication adherence among its members, numbering  270,000 across Arizona, California and Nevada. While medication adherence exceeded 80% for all of SCAN’s members, there was still a difference between races. About 86% of the company’s White members took cholesterol medications as prescribed, compared to 83% of Black members and 81% of Hispanic members, according to an essay from the company published in Harvard Business Review.

A year after launching the initiative, SCAN Health brought cholesterol medication adherence up to 87.4% for Black members, 86.6% for Hispanic members and 89.6% for White members. Similar improvements were seen in diabetes medication adherence.

SCAN officials say the company achieved the improvement in disparities by tying about 10% of its senior managers’ bonuses to their success in achieving this disparity reduction.

The company chose this course of action “to make it real,” SCAN CEO Sachin Jain said. “It’s not real until you make it real for people. Otherwise, it’s kind of like ‘Oh, yeah, it’d be great if we did this.’ And we wanted to send a strong signal to our organization that this was not something that was nice to have. This is a must do.”

Ohio doctors and pharmacists cut back the number of prescription opioids they dispensed last year, a move that continues a large-scale drop in the number of painkillers distributed across the state (Source: “Ohio doctors, pharmacists cut back on the dispensing of prescription opioids in 2021, continuing a yearslong trend,” Cleveland Plain Dealer,  Jan. 17).

Ten years after the peak of the prescription opioid crisis hit, medical providers have sharply reduced the number of pills that reach consumers. Healthcare providers across Ohio distributed 334 million opioid pills last year, nearly a 60% drop from the 793 million in 2012, according to figures released this week by the Ohio Board of Pharmacy. The numbers are based on the board’s statewide reporting system that tracks prescriptions.

Despite the drop in opioid prescriptions, the number of Ohioans who died from an overdose rose 54% from 2015 to 2020, according to an HPIO fact sheet titled “Refocusing Ohio’s Approach to Overdose Deaths.” The primary reason appears to be the increased presence of synthetic opioids (such as fentanyl and carfentanil) in the drug supply. Since 2016, fentanyl and related drugs have been the most common drugs present in unintentional overdose deaths in Ohio.

The Ohio Senate passed a bill this week that would expand medical cannabis conditions to migraines, autism spectrum disorder, opioid use disorder and any condition that could “reasonably be expected to be relieved” from the drug (Source: “Ohio Senate passes bill expanding medical marijuana to any patient whose symptoms ‘may reasonably be expected to be relieved’ by drug,” Cleveland.com, Dec. 15).

Senate Bill 261 passed 26 to 5. It now heads to the Ohio House.

In addition to broadly expanding medical conditions, the bill would change other aspects of the Ohio medical marijuana program. The bill would expand the forms of medical marijuana that can be legally sold to include pills, capsules and suppositories, oral pouches, oral strips, oral or topical sprays, salves and inhalers. Smoking marijuana would still be prohibited but vaping would continue to be allowed.

The Health Policy Institute of Ohio recently released a brief, Alcohol, Tobacco and Health: Implications for Future Cannabis Policy, that lays the groundwork for future cannabis policy discussions by applying lessons learned from tobacco and alcohol policy to upcoming decisions about recreational cannabis legalization.

The State Medical Board of Ohio on Wednesday delayed the scheduled expiration of COVID-19 emergency rules that allow for more liberal use of telemedicine, meaning Ohioans will be able to continue using telemedicine through March 2022 for doctor visits that involve prescribing drugs or renewing medical marijuana cards (Source: “Ohio COVID-19 telemed rules for medical pot, drug prescriptions extended through March 2022,” Columbus Dispatch, Nov. 10).

The extension comes as state lawmakers debate a bill that would make the COVID-19 emergency telemedicine rules permanent. 

In March 2020, as the COVID-19 pandemic took off, the medical board lifted a requirement that Ohioans must see a doctor in-person to prescribe a drug or renew medical marijuana cards. The in-person visit rule was set to expire Sept. 17 after Gov. Mike DeWine ended the COVID-19 emergency declaration. But health care organizations pushed to keep the flexibility since the virus was still circulating. The board delayed the expiration to the end of the year until Wednesday's move to extend it.

Ohio and more than 140 local governments in the state have finalized an $808 million-plus settlement with the nation’s three largest pharmaceutical distributors and drugmaker Johnson & Johnson to settle lawsuits related to the companies’ role in the opioid epidemic, Attorney General Dave Yost announced Thursday (Source: “Ohio, local governments finalize $808M opioid settlement with four drug companies,” Cleveland.com, Sept. 16).

Ohio’s agreement is part of a larger $21 billion deal to settle lawsuits filed by more than 3,000 state and local governments against Johnson & Johnson, as well as drug distributors AmerisourceBergen, McKesson and Columbus-based Cardinal Health.

The drug companies have been accused of helping to make and/or distribute billions of opioid painkiller pills in recent years despite knowing they were being abused by addicts.

Yost, a Columbus Republican, said during an online news conference that the money will be paid out over the next 18 years. Under an agreement reached last year, 55% of Ohio’s settlement money will go to a foundation that will pay for addiction treatment programs. Another 30% will go to local governments; the remaining 15% will go to the state.

The Ohio Department of Commerce announced this week that Ohio's medical marijuana cultivators can request permission to expand their grow space (Source: “Ohio to allow medical marijuana growers to expand to meet demand, prepare for more dispensaries,” Cincinnati Enquirer, Sept. 15).

Expansion requests will be granted to businesses that have complied with rules and regulations, are already using the maximum amount of space allowed by the state and demonstrate a need to expand to keep up with demand.

The expansion process comes as the state plans to more than double the number of dispensaries to sell medical marijuana and after Akron-based cultivator Fire Rock Ltd. sued the state for failing to act on its February 2020 request to expand.

Ohio has licensed 20 cultivators who can grow up to 25,000 square feet of marijuana and 15 cultivators that can grow up to 3,000 square feet. State rules allow licensees to expand to 75,000 square feet and 9,000 square feet, respectively, but didn't outline a process for requesting expansion.

The state of Ohio took a major step forward this week in reaching a massive settlement deal with distributors sued over their role in the opioid epidemic (Source: “Ohio set to reach $808 million opioid settlement after more counties, cities sign on,” Columbus Dispatch, Aug. 19).

The "OneOhio" opioid settlement now has been agreed to by more than 99% of litigating local governments – 142 of the 143 entities said yes as of Wednesday – above the absolute minimum of 96% for any deal to be considered. The only holdout, Scioto County, can still sign onto the deal until this Friday at 5 p.m.

The 96% mark, while necessary, does not guarantee that the distributors will be paying out $808 million. The companies still need to sign off on it.

If the distributors – Dublin-based Cardinal Health; McKesson, based in Texas; and AmerisourceBergen, of Pennsylvania – do give approval, roughly 30% of the money would go to local communities, which then would be used for treatment and prevention programs for opioid addiction. Another 15% would go to Ohio for legal costs, and the rest would go to a foundation controlled by local government representatives.

Ohio and other states reached a $26 billion settlement with the three largest drug distributors as well as manufacturer Johnson & Johnson that is expected to surge cash into opioid treatment and prevention programs (Source: “Ohio could get $1B from multibillion dollar deal with opiate maker and three distributors,” Columbus Dispatch, July 21).

Ohio's cut of the cash could hit $1.03 billion if local jurisdictions sign onto the agreement, according to Ohio Attorney General Dave Yost's office.

The agreement comes after nearly four years of negotiations. Under the settlement, J&J will pay up to $5 billion over nine years and the three distributors — McKesson Corp., AmerisourceBergen and Ohio-based Cardinal Health Inc. — will collectively pay up to $21 billion over 17 years. 

In March 2020, Yost and Gov. Mike DeWine announced that local governments had signed off on a plan on how opioid settlement money would be divvied up. The OneOhio agreement calls for 30% of the money to be earmarked for community recovery programs at the local level, 55% for a statewide foundation and 15% to the state.

The Ohio Department of Medicaid completed its revamp of the pharmacy benefit manager program Wednesday by awarding a contract to a company that will serve as a watchdog (Source: “As part of revamp, Ohio Medicaid hires watchdog for state-run pharmacy benefits manager,” Columbus Dispatch, April 14).

Indianapolis firm Myers and Stauffer will be paid an average of $1.5 million a year under a two-year pact that has an additional six optional years. The price tag if the deal remains in place for the entire eight years would be $12 million.

The new firm — which already manages the National Average Drug Acquisition Cost database for the federal government — essentially will act as a watchdog on a state-run PBM.

The restructuring is expected to take effect in early January. It replaces a setup that has Medicaid-hired managed-care organizations hire the pharmacy benefit managers, which act as middlemen in the drug supply chain.