The House passed consensus legislation, 393-8, on Friday intended to help combat the opioid crisis. The legislative compromise was finalized earlier this week, and now heads to the Senate for a final vote.

The two chambers came to an agreement on Tuesday, but made additional changes to the bill after the Congressional Budget Office initially estimated that the bill would increase the deficit by $44 million over the next 10 years.

The revised agreement adds two additional offsets to help pay for the bill.

The first offset would tweak pending policy changes made by a bill that the House recently cleared for Trump’s signature.

That bill, which is meant to promote drug price transparency at the pharmacy counter, also included a provision that would require the makers of expensive biotech drugs and their potential generic competitors to inform the Federal Trade Commission if they have a financial deal that would delay the introduction of a copycat drug.

The revised opioid bill would change the previously cleared drug bill in ways meant to ensure that there are no loopholes for drugmakers to avoid the disclosures to the FTC. The policy could result in savings if it results in biologic drugs facing competition from cheaper biosimilars more quickly.

The second offset would expand the religious exemption under the 2010 health care law related to the requirement that most Americans get coverage. The offset would broaden the exemption to individuals who forgo medical treatment due to religious reasons. An individual who has not received medical services in the prior year and relies only on a religious method of healing would be eligible.

CBO estimates that this offset would save $32 million over 10 years.

In addition, the revised agreement would make $31 million available from the Medicaid Improvement Fund, which was established to improve the management of the Medicaid program by the Centers for Medicare and Medicaid Services, to help oversee contracts and evaluate demonstration projects.

Support for the bill

The bicameral opioid agreement is backed by a number of advocacy and stakeholder groups including the American Society of Addiction Medicine, Advocates for Opioid Recovery, and the U.S. Chamber of Commerce.

The U.S. Chamber, in a letter sent Friday, applauded Congress’ decision to eliminate an offset included in the original House bill passed in June. That offset would have billed patient’s private insurance first before Medicare for patients with end-stage renal disease for 33 months. Currently, this is done for 30 months.

“That policy would have burdened employers already struggling to provide robust health benefits with hundreds of millions of dollars in additional health care costs,” said the U.S. Chamber in the letter.

The U.S Chamber, however, said it was disappointed that language related to privacy protections for drug and alcohol patient records was not in the final bill. A provision related to a regulation known as “Part 2” for the part of the federal regulatory code where it is found keeps a patient’s substance abuse records separate from the rest of the medical history.

House lawmakers, led by Oklahoma Republican Markwayne Mullin and Oregon Democrat Earl Blumenauer, pushed to have these records aligned with the Health Insurance Portability and Accountability Act, or HIPAA.

“I believe HR 6 could have been stronger,” said Energy and Commerce Health Subcommittee Chairman Michael C. Burgess of Texas, adding that the Mullin provision had strong support in the House and likely would be brought up again.

Burgess also voiced concerns about another provision in the bill by Democratic Rep. Paul Tonko of New York that would expand the types of health providers who can prescribe medication-assisted treatment.

“I am concerned about expanding prescriptive authority for non-physicians, and I hope we will be able to examine that again in the future,” he added.

Democrats similarly supported the bill, but voiced some minor concerns.

“There is one provision that is concerning, that I do want to mention — it did not go through regular order and was not properly vetted,” said Energy and Commerce ranking member Frank Pallone Jr. of New Jersey, referring to a proposal from Sen. Marco Rubio of Florida that was added at the last minute.

The Rubio language would create a new criminal anti-kickback statute that would prevent middlemen from receiving payments for referring patients to substance abuse treatment centers.

“I know this proposal is well-intentioned in addressing the serious problem of patient brokers who are taking advantage of individuals with opioid use disorders and referring them to substandard or fraudulent providers, in exchange for kickbacks. … Multiple stakeholders have raised concerns that the language does not do what we think it does and may have unintended consequences,” Pallone added.

Pallone did not elaborate on what exactly these consequences would be.

Senate Health, Education, Labor, and Pensions Chairman Lamar Alexander of Tennessee had previously signaled that he hopes the Senate will quickly vote on the agreement after House approval. The measure could reach the Senate floor next week.
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