Senate Passes Opioid Bill, Plans to Send to President Next Week

Kerry Dooley Young

September 18, 2018

After passing a comprehensive, bipartisan opioids package last night, Senators next predict that they will soon reach compromises with their House counterparts needed to send a broad package of opioid legislation to President Donald J. Trump next week for his signature.

Senator Lamar Alexander (R-TN), who leads the chamber's health committee, said the goal is to have a combined bill ready by Friday, allowing for a vote in the House next week. The Senate would then clear this measure shortly after, Alexander said.

There's strong support for the package of bills in the Senate, as shown in a 99-1 vote Monday night, with only Senator Mike Lee (R-UT) in the minority. 

"It's not just bipartisan, I think it's nonpartisan, in dealing with the real epidemic out there and helping the people that need it," said Senator Rob Portman (R-OH).

There were an estimated 72,000 drug overdose deaths last year in the United States because in large part of an uptick in fentanyl abuse, according to federal agencies. Known as the Opioid Crisis Response Act of 2018, the package represents work from five different committees and contributions from 72 senators, Alexander said.

The package includes a bill that Portman developed with Senator Amy Klobuchar (D-MN) to help the Post Office stop illegal drugs, including fentanyl, from being shipped into the United States from nations such as China.

The package also includes provisions intended to aid babies born in opioid withdrawal and mothers who abuse these substances. It would also give federal agencies more authority to take steps to address the crisis, such as letting the US Food and Drug Administration require manufacturers to sell opioid pills in blister packs of, say, three or seven. This approach would reduce the number of pills sent home with patients, thus reducing the risk of teens taking them without permission to try with friends.

The Senate package also calls for more early intervention with vulnerable children who have experienced trauma.

"This isn't a crisis that we can assign to a federal agency in Washington and say 'Let's fix it in 10 years,' " Alexander said. "What we can do is everything we can think of to create an environment so that doctors, nurses, judges, patients, parents, and everybody in communities that are affected by the opioid crisis can deal with it there."

Senator Joe Manchin III (D-WV) praised the bill for its inclusion of what's called Jessie's Law. This is a provision that will require the US Department of Health and Human Services (HHS) to develop standards for alerting healthcare professionals about a patient's history of opiate abuse. In this bill, HHS is directed to include in these efforts records if a patient has a history of opioid use disorder by drawing on experts in electronic health records and in the confidentiality of patient health information and records.

Manchin argued that change will allow for a commonsense approach already used broadly in medical care.

"It is so simple. You will go into a hospital to be admitted, and they are going to ask you if you are allergic and what you are allergic to, such as penicillin, and they mark it all the way through," Manchin said on Monday.

Final Details

Lawmakers are still trying to nail down the final details of the package, which they would like to see enacted before breaking for a recess ahead of the midterm election. Portman, for example, wants to change what he calls an "arbitrary cap" that limits many institutions to 16 beds for people covered by Medicaid reimbursement. This limit is a vestige of a previous policy set decades ago to get people with mental health issues out of institutional care.

"We are told that in conference we can try to work something out because the House has legislation that addresses this," Portman said.

Kelly J. Clark, MD, MBA, president of the American Society of Addiction Medicine, issued a statement praising the Senate vote, that outlines provisions her group considers crucial for inclusion in the final Senate-House compromise measure.

These include a stand-alone student loan repayment program dedicated to increasing the number of healthcare professionals who will treat substance abuse in high-need areas. The society said it's also seeking a voluntary pathway for physicians to obtain a waiver to treat patients with opioid use disorder using buprenorphine by taking approved courses during medical school or residency programs and the establishment of a grant program to support the development of addiction medicine curricula.

Separate from this bill, Congress is seeking to beef up federal spending on efforts to combat opioid abuse and addiction. An appropriations package passed in March dedicated $4.7 billion to these efforts for fiscal 2018, and the Senate this week may approve a fiscal 2019 package with $3.8 billion, Alexander said. "So that is $8 billion within a few months for the opioids crisis," said Alexander, who is also a senior member of the Appropriations Committee.

Lifting Gag Clauses

On Monday, the Senate also passed a bill in a 98-2 vote that's intended to remove so-called gag clauses that can prevent consumers from paying the lowest prices for prescription drugs. 

Its sponsors, Senators Susan Collins (R-ME) and Claire McCaskill (D-MO), said the measure would prohibit an insurer or pharmacy benefit manager from restricting a pharmacy's ability to provide drug price information to a plan enrollee when there is a difference between the cost of the drug under the plan and the cost of the drug when purchased without insurance — which can sometimes be less expensive.

In a speech to the Senate, Collins cited a recent poll by the Kaiser Family Foundation that found as many as one of five Americans does not fill a needed prescription because they are unable to afford it. She also spoke of seeing this happen at a pharmacy in Bangor, Maine. 

"When a couple ahead of me in line received their prescription, they were told by the pharmacist the copay would be $111. The husband looked to his wife and said: Honey, we just can't afford that. They turned around and walked away, leaving the prescription behind," Collins said. "I was so upset when I saw that that I asked the pharmacist: How often does this happen? His reply: Every day."

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