NCQA Research Removes Barriers to Pain Treatment for Sickle Cell Disease

October 13, 2020 · Jazmyne Carter


It’s something we all feel and it’s something we all want to stop.

Doctors often prescribe pain medications to help, but too often patients may become addicted. Policies have been put in place to help prevent opioid misuse among patients. But what about when a patient’s pain management heavily depends on these medications?

Patients suffering with sickle cell disease (SCD) are among many who need their prescriptions to manage pain crises, a hallmark of the disease. SCD comes with chronic, acute pain that can impact multiple organs and is not always clearly visible to providers. This leads to misperceptions about patients with SCD, who are predominantly African American/Black, as drug-seekers or addicts, when they seek pain medications for relief of debilitating painful episodes.

The pain from SCD is serious. In fact, SCD pain is a frequent cause of emergency department visits and hospitalization. Not to mention, it’s responsible for approximately $2.4 billion in annual health care costs in the United States.

NCQA’s Approach

With funding from the Centers for Medicare and Medicaid Services (CMS), NCQA worked to compare opioid pain management among Medicare beneficiaries with SCD to those with cancer or living in hospice, who also rely on opioids for active pain management. The results, reported in Opioid Prescription in Medicare Beneficiaries, highlight the differences in opioid prescription access and dosage among the different populations who rely on opioids for pain management.

According to the report, 80% of beneficiaries with SCD fill prescription opioids to manage pain. This compares to nearly 40% of those with cancer, 65% of those living in hospice and just 33% of the general Medicare population.

Yet, many federal policies that aimed to reduce excessive opioid prescribing only excluded certain populations, such as those with cancer and living in hospice, but not those with SCD.

There is a clear need for SCD patients to be a part of the exemption.

NCQA is proud to see that CMS used these very findings to support the recommendation to exempt beneficiaries with SCD from opioid safety edits.

This is huge.

This paves the way for thousands of SCD patients to get equitable access to adequate pain management and have an opportunity to live a better quality of life. Improving safe pain management is an important step in addressing the many health inequities this population faces.

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