Laura Hanen, Senior Policy Advisor, Venable LLP
In 2023, AAPP increased its efforts in terms of outreach and engagement with legislators, regulators, and partner organizations and weighing in on issues impacting the membership and outlined in the 2023 Health Policy Agenda. As the new year begins, we look back on the many advocacy activities AAPP was engaged in last year with the expectation that 2024 will be action packed and full of opportunity to educate and promote the vital work of psychiatric pharmacists.
Throughout the year, the Government Affairs Committee (GAC) created and revised issues briefs used in our advocacy efforts. Each issue brief describes the policy challenges and obstacles that members face and describes how psychiatric pharmacists add value in these areas and can help increase access to critical health care services. The new issue briefs are as follow:
As a reminder, the GAC previously developed a Federal Advocacy Toolkit and a State Advocacy Toolkit to assist AAPP members who wish to engage in advocacy. Policymakers continue to want to hear from providers of mental health and substance use services as they develop policy solutions to address these dual crises.
AAPP endorsed five pieces of legislation (listed below) and supported 10 more through coalition sign-on letters.
Pharmacist Scope of Practice
Throughout 2023, AAPP was an active participant of the Joint Commission of Pharmacy Practitioners (JCPP) to advocate with federal policymakers to pay for patient care services provided by pharmacists, including during the public health emergency (PHE). AAPP has been collaborating with the Hematology/Oncology Pharmacy Association and Society of Infectious Diseases Pharmacists on a strategy to pursue legislation to establish a CMMI demo to pay for clinical pharmacist services as part of a care team. The American College of Clinical Pharmacy is also onboard supporting the effort.
The Equitable Community Access to Pharmacy Services (H.R. 1770/S. 2477) was reintroduced that would allow pharmacists to provide patient care and receive reimbursement for pandemic-related services under Medicare Part B. The House bill has 96 cosponsors and the Senate bill has 13 cosponsors. There has been no movement on the bill but has served as an important vehicle for educating members of Congress on the importance of paying for patient care services provided by pharmacists. The bill was offered and withdrawn in a Senate Finance Committee markup of a Pharmacy Benefits Manager bill.
The Pharmacy and Medically Underserved Areas Enhancement Act (S. 1491) was reintroduced with bipartisan support. The legislation adds pharmacists to the list of providers whose patient care services, when delivered to patients in medically underserved communities, are covered by Medicare Part B (i.e., grant them “provider status”). The bill has 13 cosponsors and was offered and withdrawn by Senator Chuck Grassley (R-IA) in the same Senate Finance Committee markup of a Pharmacy Benefits Manager bill. There has been no movement on the bill in part due to its large cost.
AAPP has supported all activities that will open the door to payment to pharmacists for patient care services. Unfortunately, CMS continues to maintain that they do not have the authority to make clinical pharmacists qualified health providers under Medicare.
Mental Health and Substance Use Legislation
In 2023, there was much focus on the need for mental health and substance use services resulting from the COVID pandemic and record rates of suicide among youth. AAPP has been focused on educating Members of Congress on the importance of designating psychiatric pharmacists QHPs under Medicare to increase patient access to MH and SUD services.
AAPP has also been working with partners, including the American Society of Addiction Medicine to gain support for the Modernizing Opioid Treatment Access Act or MOTAA (H.R. 1359/S. 644) including the development of a fact sheet on the bill and an explainer document to counter opposition.
Also in December, the Senate HELP Committee passed the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Reauthorization Act (S. 3393) to continue and update federal SUD programs. The bill includes a provision to add the American Pharmacists Association and the Accreditation Council on Pharmacy Education to the list of organizations that can provide the 8-hour training to non-physicians that prescribe controlled substances. This was a priority for AAPP. The House also passed their version of the bill (H.R. 4531) on the House floor in December. The Senate must pass their bill and then reconcile the differences with the House to adopt a final bill.
In terms of mental health legislation, the Senate Finance Committee held a markup of the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (S. 3430) in November. The mental health provisions built upon legislation the committee developed and passed at the end of 2022. The bill includes expanding eligibility for workforce shortage area incentives to clinicians providing mental health and substance use treatment, allowing licensed clinical social workers to do more work under Medicare, and mandating that Medicare Advantage plans have accurate provider directories. AAPP sent out a grassroots alert to AAPP member to send to Senators on the Finance Committee urging their support for making psychiatric pharmacists qualified health providers prior to the markup.
Medicare Flexibilities
Maintaining Medicare telehealth flexibilities continued to be a priority for AAPP in 2023. AAPP supported telehealth provisions in broader legislation such as the Senate Finance Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (S. 3430). The telehealth provisions in the broader health care bill would require HHS to:
Teleprescribing of Controlled Substances
AAPP supports maintaining the flexibilities provided during the COVID pandemic for the prescribing of controlled substances via telehealth to ensure continued access to SUD care and treatment. AAPP weighed in with the DEA through rulemaking as well as participated in a DEA stakeholder meeting on removing barriers to treatment. In October the DEA issued a second temporary extension of the pandemic flexibilities for new practitioner-patient relationships that will expire on December 31, 2024. This will allow DEA time to incorporate feedback from their previous rulemaking and September stakeholder listening sessions into a new rule.
There is legislation to permanently allow medications for opioid use disorder to be prescribed via telehealth without an in-person visit requirement - the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act (H.R. 5163/S. 3139). The bill also permits the prescription of buprenorphine via audio-only telehealth. The bill was offered and withdrawn as an amendment in the Senate HELP markup of the SUPPORT Act by Senator Lisa Murkowski (R-AL) in the hopes that the Committee could continue to work to come to an agreement on the bill. Some Senators wanted to allow DEA more time to finalize their rule establishing a special registration process.
Congress is starting the year with a laundry list of must-pass legislation, including the annual spending bills. This will be further complicated by the wafer-thin margin in the House and the November election. Mental health, SUD, and telehealth legislation will continue to be a focus in the second session of the 118th Congress that starts on January 8. AAPP and its members will have many opportunities and will continue to provide their expertise and weigh-in with their Members of Congress and the Administration on issues of importance to the practice of psychiatric pharmacy.