DAYS TO PREPARE FOR EXPANDED REIMBURSEMENT

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Congress did their part by expanding reimbursement for non-opioid postsurgical options. Now it’s your turn.

Join the movement to choose the best non-opioid options for your Medicare patients—without added financial barriers.

Starting January 1, 2025, the NOPAIN Act will mandate that Medicare provide ASP+6% reimbursement for qualified non-opioid options used in all outpatient surgeries.1,2

ASP+6% = reimbursement of 106% of the average sales price

ABOUT THE NOPAIN ACT

The NOPAIN Act mandates that Medicare reimburse for qualified non-opioid options for all outpatient surgical procedures1

With Congress' passing of the NOPAIN (Non-Opioids Prevent Addiction in the Nation) Act, you can now provide branded non-opioids to your Medicare surgical patients for improved management of postsurgical pain—while minimizing financial barriers.1,3

reimbursement

Congress has mandated that Medicare provide ASP+6% reimbursement for qualifying non-opioid options1,2

ambulatory center

The NOPAIN Act will expand access across ASC and HOPD settings1

fda-approved

NOPAIN reimbursement will only be available for FDA-approved and proven options shown to replace or reduce the use of opioids in managing postsurgical pain1,3

Removing Barriers

Why did Congress pass this Act?

The bipartisan and bicameral NOPAIN Act was designed to increase patient and provider access to non-opioid pain management options by removing the barriers associated with reimbursement for the Medicare population. This Act is the direct result of the dedicated work of more than 100 patient advocacy and professional societies that support patient choice in postsurgical pain management.1,3

According to one of its congressional sponsors, this Act will take steps to stop future addiction before it can begin by ensuring Medicare patients have access to non-opioid options while dealing with postsurgical pain.1,3

[We] urge CMS to... separate payment for non-opioid pain management drugs in the HOPD… As the largest payer, Medicare’s policy change in this area would influence the entire health care system and meaningfully impact the opioid epidemic.4

- AHIP, 2021

IMPORTANT DATES*

Make the pact TODAY and commit to bringing the NOPAIN Act to your health system, starting January 1, 2025

Dec 2022

NOPAIN Act passed as part of the Consolidated Appropriations Act of 20231,3

Jul 2024

CMS’ preliminary OPPS rule expected to issue, defining qualifying non-opioids5

Nov 2024

CMS’ final OPPS rule expected to issue,
defining coverage rates and reimbursement codes5

Jan 2025

A new day for patient and provider access to qualifying non-opioids1

*Milestones based upon previous CMS OPPS rulings of 2023.

stay informed

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References

  1. Congress.gov. One hundred seventeenth congress of the United States of America. Accessed June 12, 2024. https://www.congress.gov/117/bills/hr2617/BILLS-117hr2617enr.pdf
  2. CMS.gov. Medicare part B drug average sales price. Updated April 2, 2024. Accessed June 12, 2024. https://www.cms.gov/medicare/payment/fee-for-service-providers/part-b-drugs/average-drug-sales-price
  3. Voices for non-opioid choices. Voices for non-opioid choices coalition applauds congress for expanding access to non-opioid pain management options in end-of-year legislative package to combat addiction crisis. Published December 23, 2022. Accessed June 12, 2024. https://nonopioidchoices.org/wp-content/uploads/2022/12/Voices-Press-Statement-NOPAIN-Act-Passage-12.23.22.pdf
  4. AHIP Letter/Brooks-LaSure 2021. Accessed June 12, 2024. https://www.regulations.gov/comment/CMS-2021-0124-18296
  5. CMS.gov. CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (CMS 1772-P). Published July 15, 2022. Accessed June 12, 2024. https://www.cms.gov/newsroom/fact-sheets/cy-2023-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center

ASC, ambulatory surgical center; ASP, average sales price; CMS, Centers for Medicare and Medicaid; FDA, US Food and Drug Administration; HOPD, hospital outpatient department; NOPAIN, Non-Opioids Prevent Addiction in the Nation; OPPS, outpatient prospective payment system.