U.S. House of Representatives Passes NACDS Policy Recommendations in Opioid Bill

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NACDS lauds Congress’ decisions on e-prescribing, initial fills, drug disposal, PDMPs – and enhanced MTM eligibility

“NACDS’ public policy recommendations on opioid-abuse prevention build are guided by pharmacists’ experiences on the front lines of patient care."

The opioid-abuse-prevention legislation crafted by U.S. Senate and U.S. House of Representatives negotiators reflects aspects of all four of the policy topics recommended by the National Association of Chain Drug Stores (NACDS). The House passed the bill today, and the Senate anticipates voting next week.

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.

“NACDS’ public policy recommendations on opioid-abuse prevention build are guided by pharmacists’ experiences on the front lines of patient care. They build on NACDS’ consistent engagement on this issue, and on NACDS members’ ongoing role as part of the solution to opioid abuse, in collaboration with law enforcement,” said NACDS President and CEO Steven C. Anderson, IOM, CAE. “We thank the champions of this legislation in the Congress for soliciting broad perspectives on this issue, and for crafting a well-reasoned package that is strongly supported on a bipartisan basis, and that is focused on preventing abuse while preserving patient care. NACDS remains committed to working with all branches and all levels of government on this vital issue.”

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-IA) with the original co-sponsorship of Sen. Chuck Grassley (R-IA) and Sen. Richard Blumenthal (D-CT), and in the House by Rep. David B. McKinley (R-WV), Rep. Paul Tonko (D-NY), Tom Marino (R-PA), and David Cicilline (D-RI). 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.

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