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House, Senate agree on broad opioid legislation


Leaders in the House and the Senate have agreed to a final legislative package to address the opioid crisis.

Alicia Ault/MDedge News

The consensus legislation, called the Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (H.R. 6), combines a House bill of the same name passed in June with the Opioid Crisis Response Act (S. 2680), passed by the Senate by a 99-1 vote on Sept. 17.

A number of provisions would affect medical practice directly, by:

  • Allowing Medicare to pay clinicians to provide substance-use disorder treatment via telemedicine.
  • Adding to the Welcome to Medicare exam as well as the annual physical a review of beneficiary’s opioid prescriptions, screening for potential abuse, and referral to appropriate treatment services, if necessary.
  • Requiring controlled substance prescriptions covered by Part D to be transmitted electronically beginning Jan. 1, 2021.
  • Allowing physicians who recently graduated in good standing from an accredited school and who have appropriate training to prescribe medication-assisted therapy.
  • Requiring CMS to notify prescribers if they are identified as statistical outliers when it comes to prescribing opioids, as compared with their peers.

“The bill will make a real difference in Medicare, a program in which one in three beneficiaries is prescribed an opioid,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said Sept .17 during Senate floor debate.

“It will empower patients through information on pain treatment alternatives. It will expand treatment options for patients suffering from addiction, including through increased access to care via telehealth,” he said. “The bill also increases the ability to track opioid prescriptions to prevent misuse and diversion, while also ensuring that beneficiaries promptly get the medications they need.”

The bill also requires the Food and Drug Administration to issue guidance on expedited pathways for approval of new nonaddictive pain treatments and on the appropriate use of pain endpoints across agency divisions as well as clarification on requirements on how opioid-sparing data is to be used on labels.

The combined legislation also clarifies the FDA’s authority to require drug manufacturers to package opioids in three- and seven-supply blister packs, as well as requiring manufacturers to provide patients with simple and safe options to dispose of unused opioids.

The combined bill addresses one of the criticisms of the Senate-passed version.

Sen. Edward Markey (D-Mass.) noted the absence of a provision that would have given nurse practitioners and physician assistants permanent prescribing authority for medication-assisted therapies.

“This is a missed opportunity to build upon our commitment to treatment,” he said on the Senate floor.

The final version of H.R. 6 that will be voted on by both chambers includes the House-passed provision.

At press time, votes on the combined bill had not been scheduled.

Sen. Margaret Wood Hassan (D-N.H.) warned the Congress not to get complacent.

“This legislation is a vital next step in our efforts to combat this crisis,” she said. “The biggest mistake anyone could make is thinking that our efforts are anywhere close to being done.”

A section-by-section summary of the bill can be found here.

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