Outpatient, ASC clinicians share perspectives on upcoming NOPAIN Act implementation

Editor's Note

On October 14, Anesthesiology News published a monograph featuring clinical perspectives on how “those working in the trenches of postsurgical pain management” are preparing for the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, which outlines new, separate Medicare reimbursement for certain non-opioid analgesics in outpatient and ambulatory care settings.

Set to take effect January 1, 2025, the act aims to expand access to certain FDA-approved nonopioids by mandating separate Medicare reimbursement that equals the average sales price, plus 6% for outpatient and ambulatory surgery center (ASC) environments. Drugs specified in a proposed ruling from the Centers for Medicare & Medicaid Services (CMS) have been identified as reducing or avoiding intraoperative or postoperative opioid use. This includes six specific branded medications: EXPAREL, OMIDRIA, DEXTENZA,  Ketorolac tromethamine injection, XARACOLL, and ZYNRELEF. 

Among other topics, the queried experts offer extensive testimony on topics includeing the potential impact of the new CMS reimbursement on minimizing opioid use at their practices; the impact on the bottom line; whether the new CMS reimbursement would help in discussions with health-system administrators; challenges encountered in providing access to branded non-opioids; and challenges in obtaining approval to incorporate them.

“Use of non-opioids as part of an HOPD’s or ASC’s clinical pathway optimizes patient care from managing pain immediately after surgery to recovery at home,” the monograph concludes.  “This legislation draws national attention to the importance of non-opioid postsurgical pain management treatments and emphasizes the importance of providing greater access to these options across more patient populations. Effective and timely implementation of this new reimbursement will benefit hospital systems and the patients they are treating.