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By District Policy Group

Throughout 2018 and in lead up to the mid-term elections, Congress and the Administration have kept an ambitious agenda marked with several successful bipartisan efforts despite operating under a compressed legislative calendar and increasing political tensions. This year marked the first time in 20 years that Congress has passed a bill funding programs for the Departments of Health and Human Services, Education, and Labor prior to the end of the fiscal year and the first time in ten years they’ve passed funding for the Department of Defense prior to the fiscal year end. In addition, Washington ramped up efforts to address prescription drug prices and the opioid epidemic, culminating in a flurry of regulatory agency activities and the passage of legislative package H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act, signed by the President on October 24, 2018.

At the start of 2018, CPNP announced that we would be launching into the next phase of our government affairs activities by moving from an education and relationship building agenda to a more policy driven approach that would be led by the 2018 Health Policy Agenda. The policy agenda was created by CPNP’s Government Affairs Committee and finalized by the CPNP Board of Directors at the start of the 2018. Part of CPNP’s strategy to pursue a more policy driven approach was to be nimble in evaluating opportunities to influence the policymaking process and to target activities that would maximize our efforts while remaining true to the Health Policy Agenda and CPNP’s goals to advance the practice of our members. As a result, CPNP’s government affairs activities were driven largely by Congress’s agenda as they primarily sought to tackle policies relating to the treatment of opioid use disorders as well as other substances use and mental health disorders.

CPNP Advocacy Efforts in Relation to Addressing the Opioid Epidemic

In the first quarter of 2018, Congress took up major spending legislation that included roughly $4 billion spread across the Administration for prevention, treatment, and law enforcement efforts to fight the opioid crisis. Quickly following, Congressional health care committees commenced work dedicating the majority of their health care staff to the consideration of policies that would potentially be included in a legislative package by end-of-year to address the epidemic.

In response, CPNP engaged key offices and tailored our efforts in order to highlight the role of psychiatric pharmacists and to recommend policy solutions that would help advance the practice of psychiatric pharmacists and treat those struggling with mental health and substance use disorders. As part of these efforts, CPNP created the Addressing Gaps in the Treatment of Opioid and Substance Use Disorders issue brief, which was shared in all Hill visits and frequently made available as a resource to offices and other stakeholder groups seeking to understand the role of psychiatric pharmacists in the delivery of mental health and addiction treatment. Included in the issue brief and reiterated throughout our formal and informal communications with Hill staff were two primary policy recommendations:

  1. Recognize clinical pharmacists as providers and allow Medicare to reimburse pharmacists for providing Part B services, which would otherwise be provided by a physician, NP or PA.

Commonly referred to as seeking “provider status,” CPNP supplements the organization’s efforts on this issue through our involvement in the PAPCC coalition and with other stakeholder groups to advocate for provider status.

  1. Remove the barriers that prevent psychiatric pharmacists from prescribing opioid addiction treatments like buprenorphine.

Commonly referred to as seeking “prescriptive authority” or as seeking to become a “DATA waivered provider.” Similar to the issue of provider status, CPNP has sought to engage with other stakeholders on this issue to supplement our individual efforts in advocating for prescriptive authority.

Despite our significant efforts put forward as an organization and in collaboration with others, neither of these policies were ultimately included in H.R. 6 as signed into law. Still, CPNP was strongly encouraged by the level of interest shown by Hill staff in seeking to understand the profession and reflected in their outreach to CPNP to receive feedback on policy considerations as they were under development. Heading into 2019 and the start of the 116th Congress, we see increasingly meaningful opportunities for continued development of these relationships and advancement of our policy priorities.

Looking more broadly, it is important to note that included in the law are a number of items that CPNP believes will be positive and will create opportunities for pharmacists going forward. Among these are provisions that seek to improve and expand access to treatment and recovery centers, access to mental health services, prescription drug monitoring programs, and medication-assisted treatment (MAT). The Department of Health and Human Services (HHS) and more specifically the Centers for Medicare and Medicaid Services (CMS) is now tasked with implementation. Even prior to the law’s passage, CMS sought comments on changes related to MAT and non-MAT associated management and counseling for SUDs – CPNP responded with in a comment letter available here. Therefore, in addition to our continued engagement with Congressional offices, CPNP will be actively working to engage CMS to promote the utilization of psychiatric pharmacists through their rulemaking process.

Mid-terms and 2019

The mid-term elections, which will be held on Nov. 6th, are expected to bring a large new wave of faces into Congress with almost 70 Members of the 115th leaving due to retirement or resignation. There’s also an increasing belief that the House of Representatives will flip and Democrats will hold the majority in the 116th Congress beginning in 2019, although Republicans are expected to retain control of the Senate. Regardless of election outcomes, there will be a large shift in Committee leadership and composition in both the House and Senate. Therefore, we can expect there will be a great deal of work to do in terms of educating these new members and working to build new and existing Members into champions to support CPNP’s priorities.  

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