House Panel Advances Opioid Legislation, Readies More

Kerry Dooley Young

May 09, 2018

WASHINGTON — A House panel approved more than 20 bills intended to address the national opioid crisis, including a proposed study of Medicare Part D policies and a bid for a new loan-repayment plan for medical professionals willing to serve hard-hit communities.

The House Energy and Commerce Committee on Wednesday approved these largely noncontroversial measures in a series of voice votes. The committee will work on another set of bills related to opioid abuse at a May 17 markup.

"Some of the more complicated issues will be taken up then," House Energy and Commerce Chairman Greg Walden (R-OR) said as he closed the Wednesday markup session.

Democrats may seek at next week's markup to delve more deeply into questions about the costs of medicines, including the opioid overdose reversal agent naloxone. President Donald J. Trump is expected to give a speech on drug prices on Friday afternoon outlining steps his administration will consider, Rep. Jan Schakowsky (D-IL) noted.

"There are many things I hope he includes, but one area we should all be unified on is lowering the price of naloxone through negotiation," Schakowsky said at the Wednesday markup. "We cannot allow pharmaceutical corporations to profit from this epidemic. It is unacceptable."

Schakowsky also thanked a GOP colleague, Rep. Earl L. "Buddy" Carter (R-GA), for addressing in his Abuse Deterrent Access bill the difficulties senior citizens have in paying for their pain medications. The bill would direct the US Department of Health and Human Services (HHS) to conduct a study on the adequacy of access to abuse-deterrent opioid formulations for people with chronic pain who use Medicare Part D plans.

Carter, who is a pharmacist, said these plans often limit people who need opioids for severe pain to traditional forms of these drugs instead of letting them use the abuse-deterrent forms.

Plans have in place "barriers" such as cost-sharing tiers, fail-first requirements, and prior authorization requirements, Carter said. It is important to offer safeguards for people who rely on these strong pain medications, even while trying to contain their use in the general population, he said.

"There are still individuals who have severe legitimate chronic pain and need access to opioids abuse-deterrent formulations," Carter said at the markup before the committee approved his bill.

Jessie's Law

Energy and Commerce chief Walden and his Senate counterpart are aiming to clear a package of opioid legislation this year despite the challenges of completing any major bills in election years. The US Senate Committee on Health, Education, Labor and Pensions (HELP), led by Lamar Alexander (R-TN), last month passed its own package of opioid legislation.

There are many areas of bipartisan overlap between the two committees' plans. Both show an interest in making it easier for physicians to learn about patients' history with substance abuse. The House Energy and Commerce Committee on Wednesday approved by vote voice a bipartisan bill known as Jessie's Law. It would require HHS to develop and disseminate best practices for prominently displaying a note about past opioid abuse in medical histories of patients who agree to share this information. The Senate bill also includes Jessie's Law.

Appropriators, who control HHS' budget, already have urged the department to get to work on this initiative. In a report written to accompany fiscal 2018 HHS funding, the Senate Appropriations Committee sought the creation and dissemination of "standards that would allow hospitals and physicians to access the history of opioid addiction in medical records (including electronic health records) of any patient who has provided information about such addiction to a healthcare provider."

On Wednesday, the Energy and Commerce Committee also approved the Substance Use Disorder Workforce Loan Repayment bill. It would offer student loan repayment of up to $250,000 for medical professionals who agree to work in substance-abuse treatment in areas most in need of their services.

The committee also approved a measure that would promote the testing of incentive payments for behavioral health providers for adoption and use of certified electronic health record technology. Another bill approved by the committee would help support the establishment of Comprehensive Opioid Recovery Centers to serve as models for comprehensive treatment and recovery.

OTC Reform

The Energy and Commerce Committee also marked up bills that were not part of its response to the opioid crisis. These included the bipartisan Over-the-Counter (OTC) Monograph Safety, Innovation, and Reform Act of 2018 for a major overhaul of the monograph system that the US Food and Drug Administration uses for medicines sold without prescription. The bill would authorize facility fees totaling $22 million for fiscal year 2019 and incrementally increase the fees to $34 million in fiscal year 2023, according to a memo from the House Energy and Commerce Committee.

Rep. Frank Pallone Jr of New Jersey, the ranking Democrat on the House Energy and Commerce Committee, offered an amendment to slim back a period of exclusivity in the bill for OTC to 12 months from the 18 months included in the bill. Schakowsky joined him in seeking to shorten the exclusivity period, calling it a "handout" to drug makers. She said she worried about delaying competition, and thus the resulting price decreases, in cases where prescription medicines are switched to over-the-counter status. Companies also could make changes in delivery methods of medicines to seek to block competition, she said.

Rep. Robert Latta (R-OH) disagreed, arguing that many new OTC product launches fail. "It takes a year or more to develop awareness and acceptance," Latta said. "That new launch needs that corner of the shelf to get started.

The panel voted 30-24 along party lines to defeat the Pallone amendment.

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