ASHP Urges Senate to Pass Opioid Bill Containing Key Provisions

RE: Opioid Epidemic

Dear Leader McConnell, Leader Schumer, Assistant Leader Cornyn, and Assistant Leader Durbin:

On behalf of ASHP (American Society of Health-System Pharmacists), I commend you on your efforts to address the opioid epidemic in the United States. ASHP represents pharmacists who serve as patient care providers in acute and ambulatory settings. The organization’s 45,000 members include pharmacists, student pharmacists, and pharmacy technicians. For more than 75 years, ASHP has been at the forefront of efforts to improve medication use and enhance patient safety.

Pharmacists are uniquely qualified to provide the type of medication and disease management (including behavioral health conditions) needed to address the opioid epidemic. Pharmacists offer an in-depth knowledge of medications that is unmatched in the healthcare arena. Pharmacists today earn clinically based Doctor of Pharmacy degrees (Pharm.D.), and many also complete postgraduate residencies and become board certified in a variety of specialties. Pharmacists in hospitals and ambulatory clinics work with physicians, nurses, and other providers on interprofessional teams to manage patients’ medications and ensure appropriate care transitions.

Patient care discussions often revolve around the pathophysiology of disease or chronic condition, but far too often patients receive little information regarding perhaps the most essential part of treatment — the medication prescribed to cure or manage the condition. In many cases, the prescribing clinician does not have the same medication expertise as a pharmacist. Thus, to ensure appropriate medication use, as well as to manage pain and prevent and treat medication-misuse disorder effectively, pharmacists must play a more prominent role in medication selection and modification, patient education, follow-up and monitoring of medication, and overall treatment.

Pharmacists are the most patient-accessible providers, working on the frontlines of patient care across the continuum of care to collaborate with and carry out the plan of the initial opioid prescriber. In addition, pharmacists have expertise and experience in managing opioids throughout the entire medication-use cycle, spanning from medication procurement and storage to patient and prescriber education to dispensing to disposal.

On June 22, 2018, the House of Representatives passed H.R. 6, the “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act.” This legislation encompasses dozens of opioid-related bills that House committees discussed earlier. ASHP supports many of the bill’s provisions, including the following:

• Encouraging the use of non-opioid analgesics for the management of postsurgical pain in Medicare beneficiaries
• Requiring Medicaid providers to check their state’s prescription drug monitoring program before prescribing a Schedule II controlled substance
• Evaluating the use of telehealth services in treating substance use disorder (SUD)
• Requiring e-prescribing of controlled substances under Medicare Part D
• Assisting pharmacists in identifying fraudulent prescriptions
• Increasing access to a patient’s complete health history, including any prior or current SUD history

Medications, such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid use disorder. H.R. 6 also makes the buprenorphine prescribing authority for physician assistants and nurse practitioners permanent and temporarily allows advanced practice registered nurses to prescribe buprenorphine. In addition, H.R. 6 will permit a waivered-practitioner to immediately start treating 100 patients at a time with buprenorphine (skipping the initial 30-patient cap) if the practitioner has board certification in addiction medicine or addiction psychiatry, or if the practitioner provides MAT in a qualified practice setting. Should the Senate choose to include this provision in its legislation, we urge you to include pharmacists in that list of providers, where allowed by their state scopes of practice.

We look forward to continuing to work with the Senate on addressing this public health crisis. Should you have any questions or comments as the legislative process progresses, please contact me or have a member of your team contact Christopher Topoleski, Director of Federal Legislative Affairs, at 301-664-8806 or at [email protected].

Sincerely,

Kasey K. Thompson, Pharm.D., M.S., M.B.A.
Chief Operating Officer and Senior Vice President