ARLINGTON, Va. – This week the U.S. Senate passed the opioid-abuse-prevention legislation that reflects aspects of all four of the policy topics recommended by the National Association of Chain Drug Stores (NACDS), and that the U.S. House of Representatives passed on September 28. The bill now goes to President Trump for consideration, and the White House has indicated the President’s intent to sign it into law.
“NACDS commends the bipartisan and effective process on this legislation that was led in the Senate by Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R, Tenn.); Finance Committee Chairman Orrin Hatch (R, Utah); and Judiciary Committee Chairman Chuck Grassley (R, Iowa). We also commend the Senators who authored the individual bills that ultimately contributed to this comprehensive measure,” said NACDS president and chief executive officer Steven Anderson.
“NACDS appreciates the opportunity to engage in this process, by offering legislative recommendations that are based on pharmacists’ first-hand experiences, and that build on NACDS members’ ongoing work to serve as part of the opioid-abuse solution. Similarly, NACDS will continue to engage with the Executive Branch agencies and with the Congress, including in the areas for which the bill calls for additional input from stakeholders throughout the implementation process.”
The SUPPORT for Patients and Communities Act (H.R. 6) includes the provisions of the NACDS-backed electronic prescribing bill, as well as the provisions of an NACDS-backed drug disposal bill that is consistent with the flexibility urged by NACDS and with pharmacies’ current initiatives. The bill also reflects the spirit of NACDS’ recommendations on prescription drug monitoring programs (PDMP) and on initial-fill limits for acute pain.
In addition to reflecting NACDS’ opioid-specific policy recommendations, which NACDS announced on October 24, 2017, H.R. 6 also enhances eligibility for the Medicare Part D Medication Therapy Management (MTM) program to include at-risk beneficiaries.
The legislation includes the Every Prescription Conveyed Securely Act, which would require electronic prescribing for Schedule II through V controlled substances prescriptions covered under Medicare Part D to help prevent fraud, abuse and waste – with limited exceptions to ensure patient access. Sens. Michael Bennet (D-CO) and Dean Heller (R-NV) introduced the Senate version, with the original co-sponsorship of Sens. Elizabeth Warren (D-MA) and Pat Toomey (R-PA). The House of Representatives version was introduced by Rep. Katherine Clark (D-MA) and Rep. Markwayne Mullin (R-OK).
Of importance, state legislatures and executive branches are taking action to advance electronic prescribing as well. Six states have enacted some sort of mandatory electronic prescribing legislation this year, bringing the total number of states with some sort of NACDS-backed provision to 12. Legislation is pending in other states. Reflective of the journey toward greater use of electronic prescribing as a safeguard, NACDS was on the leading edge of working with the Drug Enforcement Administration to allow electronic prescribing of controlled substances. Until 2010, it was not even allowed.
In a January 2018 national survey conducted by Morning Consult and commissioned by NACDS, three-in-four voters – on a non-partisan basis – supported rules that all prescriptions must be handled electronically, rather than by paper or fax, as a way to help address the opioid abuse epidemic. Three-in-four also supported limiting the initial fill of certain opioid prescriptions to seven days.
Regarding drug disposal, H.R. 6 reflects the Access to Increased Drug Disposal Act (S. 2645 and H.R. 5628) – which was introduced in the Senate by Sen. Joni Ernst (R, Iowa) with the original co-sponsorship of Sen. Chuck Grassley (R-IA) and Sen. Richard Blumenthal (D, Con.), and in the House by Rep. David B. McKinley (R, W. Va.), Rep. Paul Tonko (D, N.Y), Tom Marino (R, Pa.), and David Cicilline (D, R.I.). The related provisions will create a demonstration program to provide federal grant funding to states to assist drug disposal authorized collectors with the cost to purchase, install, and maintain drug take-back kiosks; the cost to dispose of collected unwanted prescription drugs; and the cost to train staff in operating the kiosks with the goal of improving take-back programs and participation in the states.
Regarding limits on some initial fills of opioids for acute pain, members of Congress opted against language that could have jeopardized current initiatives in this area.
Regarding PDMPs, the legislation takes important technical steps to facilitate a collaborative and inter-connected system that provides meaningful prescribing information to healthcare providers that can help prevent fraud, waste and abuse.
The policy recommendations issued by NACDS complement longstanding and ongoing pharmacy initiatives to prevent opioid abuse, including compliance programs; pioneering e-prescribing; drug disposal; patient education; security initiatives; fostering naloxone access; stopping illegal online drug-sellers and rogue clinics; and more.
NACDS’ Chain Pharmacy Community Engagement Report indicates that opioid abuse prevention stands as one of the top priorities for NACDS members among their community engagement initiatives.