The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (“SUPPORT Act”) was signed into law by the President on October 24, 2018, after passing the House and Senate with bipartisan support. A press release issued by the Senate explained that the Act aims to target the opioid epidemic by reducing supply, encouraging recovery, supporting caregivers and families affected by the disease, and enabling innovation that seeks long term solutions—such as non-addictive pain management. The new provisions apply to both commercial and public insurance programs, with a number of positive changes seeking to increase access to treatment and support communities affected by the opioid epidemic.
Key provisions of the bill include:
- Requiring the US Postal Service to screen packages coming from overseas for fentanyl;
- From October 2020 through September 2025 all state Medicaid programs are required to cover approved medication-assisted treatment (MAT) drugs, unless the state certifies that implementation is not possible due to a lack of providers;
- Funding for comprehensive community-based opioid recovery centers that include housing and job placement services;
- Increasing access to MAT, including for Medicaid and Medicare enrollees;
- Increasing possession and usage of naloxone by first responders to reverse overdoses and reduce overdose death;
- Seeking to prevent over-prescription of opioids by the Medicare and Medicaid programs;
- Allowing 30 days of residential treatment coverage under Medicaid and eliminating the prohibition on Medicaid paying for coverage of patients in a mental health facility with more than sixteen beds.
One interesting element of the SUPPORT Act is its promotion of telemedicine to tackle the growing demand for recovery and addiction assistance. In September 2018, the U.S Department of Health and Human Services (HHS) released guidance clarifying recent changes made to expand access to MAT treatment. The guidance indicated that Drug Enforcement Agency-registered providers engaged in the practice of telemedicine would be exempt from the in-person medical evaluation requirement associated with the dispensing of controlled substances. This change seeks to expand access to qualified physicians and allow those in need of MAT without easy access to these services to continue the recovery process. HHS recently released materials for practitioners on how telemedicine can be utilized to provide MAT, in particular for those patients that may encounter access issues. The support of telemedicine is also an avenue for regulators to explore as they continue to struggle with issues of access to MAT and substance abuse disorder treatment. Additionally, many states approaching the legislative cycle can use this time to promote and support health insurers as they explore this option.
 As noted in the September 2018 guidance from HHS, “one particular barrier to MAT access is the limited number of practitioners with a Drug Addiction Treatment Act of 2000 (“DATA 2000”) waiver, which allows qualified practitioners to prescribe buprenorphine, for the treatment of opioid use disorder in settings other than a federally regulated opioid treatment program.”