On October 3, Congress passed bipartisan legislation to combat the opioid crisis. This comprehensive package is the result of months of negotiations by eight House committees and five Senate committees.
H.R. 6, the SUPPORT for Patients and Communities Act, authored by House Energy and Commerce Committee Chairman Greg Walden, is a comprehensive bill whose provisions fall under four main areas:
- Treatment and recovery
- Protecting communities
- Fighting fentanyl abuse
The bill will lead to Medicaid changes such as drug management programs for at-risk beneficiaries, additional drug review and utilization requirements, and coverage for medication-assisted treatment (MAT). Changes within Medicare will include stricter electronic prescribing and postsurgical pain management along with a required initial opioid use disorder screen for new enrollees. Other Medicare changes include requirements for Part D Plans to establish drug management programs for at-risk beneficiaries’ coverage for certified opioid treatment programs.
H.R. 6 will establish and expand public health programs that can detect and monitor synthetic opioids such as fentanyl. Other changes include increasing the maximum number of patients that practitioners initially can treat with MAT and advising the FDA on ways to bring non-addictive pain treatment for patients.
The following is a summary of ASHP-supported provisions incorporated in the H.R. 6 bill. A full section-by-section summary can be found here:
- Prevention of overdoses in the Emergency Department (ED) — Improvement of substance screening and treatment for substance-use disorder (SUD) patients in the ED, including the use of recovery coaches after a non-fatal overdose and a grant program to promote integrated models of care for non-fatal overdose patients (Section 7081). ASHP strongly supports team-based care that includes pharmacists.
- Initiation of opioid alternative programs in the ED — Initiation of protocols to manage pain using non-opioid alternatives in the ED including training for hospital personnel and use of best practices for prescribing and treatment with opioid alternatives (Section 7091)
- Requirement of an opioid addiction history noted in patient’s history — A requirement for HHS to create a system that displays SUD treatment in electronic health records (Section 7051). Pharmacists will also have access to these records.
- IMD Care Act — A lift to the 16-bed restriction, including an expansion to Medicaid reimbursement for up to 30 days in patients between 21 and 64 years old receiving SUD treatment (Section 5052)
- Grants that will support access to SUD treatment — Authorization of grants to develop programs that help practitioners obtain medication-assisted treatment (MAT) waivers (Section 3203)
- Pharmacy-delivered controlled substances by injection or implantation — Authorization for pharmacies to deliver SUD injectable or implantable medications to healthcare providers (Section 3204)
- Medication access expansion in an inpatient setting — An expansion of Medicaid reimbursement for providers in inpatient settings who treat opioid use disorder with two types of medicines (Section 5052). States may expand Medicaid coverage to include additional services such as outpatient and community-based substance use disorder treatment; evidence-based recovery and support services; clinically directed therapeutic treatment to facilitate recovery skills, relapse prevention, and emotional coping strategies; outpatient medication-assisted treatment, related therapies, and pharmacology; counseling and clinical monitoring. ASHP is encouraged by this expansion as pharmacists can play a key role in these areas. Further, a January 2017 guidance by CMS urged state Medicaid programs to utilize pharmacists to combat the opioid crisis, as did a 2015 report from the National Governors Association.
- Safety packaging and disposal features — FDA requirement to manufacturing companies to package certain opioids that will allow a set duration of treatment, such as blister packs with 3- or 7-day limitations. This provision also addresses FDA’s authority to require manufacturing companies to provide safe opioid disposal options for unused opioids. (Section 3032)
Where ASHP Stands
ASHP remains supportive of H.R. 6 and its provisions aimed at opioid abuse treatment, recovery, training, and education. The legislation will help fulfill a public health need to address the opioid crisis. ASHP has been engaged with key congressional committees in support of the provisions listed above, and will continue to work with federal agencies and states on implementation. Pharmacists can help fight the opioid epidemic by managing and optimizing the impact of medications, reviewing medications to tailor care plans to patient needs, providing recommendations for non-opioid pain management alternatives, and educating patients regarding opioids. ASHP is encouraged by the expansion of Medicaid coverage for opioid treatment, and we believe there may be opportunities through state scopes of practice and state Medicaid programs to further advance the patient care role of pharmacists.
During the legislative process, ASHP requested on numerous occasions that pharmacists be included in the expanded list of recognized providers who can manage MAT and we will continue to advocate for their inclusion.