The CME Coalition has submitted comments to Reps. Diana DeGette (D-CO) and Fred Upton (R-MI) in response to their solicitation for comments on ‘Cures 2.0’ — an important next step in their efforts to advance medical research and foster innovation.  As the letter points out, policymakers have increasingly recognized that there is an important role for enhanced provider education to address discrete policy challenges.
​Key examples of this cited in the letter include the Centers for Medicare and Medicaid Services (CMS)  policy to incentivize medical education for providers by recognizing Quality Improvement CME (QI-CME) as an 'Improvement Activity' under the Merit-Based Incentive Payment System (MIPS).  Additionally, the Food and Drug Administration (FDA) has acknowledged the role of CME in combating opioid misuse by leveraging continuing education on safe prescribing and safe use practices in their Risk Evaluation and Mitigation Strategy (REMS) for opioids. And most recently, the House Energy & Commerce and Senate HELP committees included a provision in their bipartisan surprise billing and drug pricing legislation that would direct the Department of Health and Human Services (HHS) to improve continuing education for health care providers regarding lower cost biosimilar products.

​​Looking forward, as lawmakers consider policies to support access to new medications, we encourage them to keep in mind the essential role in educating America’s health care professionals to adopt and administer these groundbreaking treatments. The CME Coalition offers significant expertise in this area — representing over 40 leading CME providers and supporters who facilitate programs that impact more than 2,000,000 physicians, nurses, and pharmacists annually — and we look forward to being a part of this dialogue in the months ahead. 

As part of the Coalition’s ongoing monitoring and analysis of legislative opportunities related to CME, the Coalition has reviewed all relevant legislation that has been introduced in the 115th Congress and generated a new document outlining specific bills that prioritize the essential role of CME in improving health outcomes
​This year, the most pressing legislative priority in Congress related to CME has been opioid prescriber education. Recently, the House Energy and Commerce Subcommittee on Health passed a bill that would direct CMS to work with Quality Improvement Organizations to engage in outreach with prescribers identified as clinical outliers to share best practices. This bill replaced earlier legislation that was under consideration in the Subcommittee, the Opioid PACE Act, which would have required all opioid prescribers to under 12 hours of CME.

Nearly 100 million people in the United States, or roughly one-third of the population, experience some form of chronic pain. Meanwhile, prescription opiate abuse and addiction have reached epidemic proportions in the United States, including the widespread illegal diversion of prescription opioids for street use, which in turn can increase the rates of abuse of illegal narcotics. Some clinicians have also prescribed opioids without adequate training surrounding their abuse potential. Many primary-care providers have recently become reluctant to prescribe opioid pain relievers in the context of current public health concerns surrounding addiction, which leads to some chronic pain patients now going without any appropriate treatment. 

​CME has been proven to be a critical in educating physicians about the inherent risks in prescribing opioid medications. Over the course of 39 systematic reviews published between 1977 and 2014, the Accreditation Council for Continuing Medical Education (ACCME) has concluded that CME courses “can more reliably change health professionals’ knowledge and competence than their performance and patient health outcomes.” This video, produced by CME Coalition member Academy for Continued Healthcare Learning (ACHL), provides a sample of a CME activity intended to educate physicians, pharmacists, and other allied-health personnel on the latest guidelines surrounding prescription opioids as well as the latest epidemiological data surrounding addiction management and treatment.​

On May 3 and 4, 2017, the Food and Drug Administration (FDA) convened a public workshop (agenda) examining “Training Health Care Providers on Pain Management and Safe Use of Opioid Analgesics.” Andy Rosenberg presented testimony on behalf of the CME Coalition, in which he spoke to the role of CME in opioid prescriber education. Among the key points made in Andy’s remarks, "FDA should continue to rely on accredited CME as a vital tool in prescriber education in the opioid space. The strength of CME is that it can produce myriad educational activities that are targeted to physicians based on their professional practice gaps, individualized needs, and stages of learning and change. Added flexibility will allow prescriber education to better address individual prescribers’ educational and practice needs... Finally, as an incentive for prescribers to participate in opioid REMS, we recommend that the FDA encourage CMS to include opioid REMS as an improvement activity in the Quality Payment Program MIPS.”

On May 3-4, 2016, the Food and Drug Administration (FDA) hosted a two-day long Joint Meeting of the Drug Safety and Risk Management Advisory Committee (DSaRM) and the Anesthetic and Analgesic Drug Products Advisory Committee (AADPAC) to discuss results from assessments of the extended-release and long-acting (ER/LA) Opioid Analgesics REMS.  The CME Coalition submitted public comments following the meeting, emphasizing that ​FDA should consider standardizing the REMS process, while allowing more flexibility in content. The Coalition also suggested that REMS should be expanded to include short acting opioids. 
As detailed further in the formal comments, the Coalition emphasized that "the strength of CME is that it can produce myriad educational activities that are targeted to physicians based on their professional practice gaps, individualized needs, and stages of learning and change. Added flexibility will allow prescriber education to better address individual prescribers’ educational and practice needs. The effectiveness of REMS can also be measured in terms of how successfully it promotes access to education and draws the attention of the medical profession to a problem."

"... While extended release and long acting opioids can be abused, short acting opioids are even more likely to be abused and therefore, much more difficult to manage. We agree with the FDA’s stated position that REMS be expanded to SA-IR, and create a single blueprint for all opioids. We are encouraged that the FDA sees CME as a valuable tool in combatting the opioids epidemic. Our members have created hundreds of hours of pain education programs and have delivered them to hundreds of thousands of physicians. Through their research and experience, we believe that, rather than requiring the whole three to six hours of content outlined in the blueprint, that counting credit hours towards a goal of three hours of REMS education should be considered."