I 
115TH CONGRESS 
2D SESSION 
H. R. 5635 
To amend title XIX of the Social Security Act to impose restrictions under 
the Medicaid program with respect to opioid prescriptions, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 26, 2018 
Mr. GROTHMAN introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to impose 
restrictions under the Medicaid program with respect 
to opioid prescriptions, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Responsible Opioid 
Prescription Act’’. 
VerDate Sep 11 2014 
05:14 May 05, 2018
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5635.IH
H5635
lotter on DSKBCFDHB2PROD with BILLS
SEC. 2. MEDICAID RESTRICTIONS RELATING TO OPIOID 
PRESCRIPTIONS. 
(a) IN GENERAL.—Section 1927(d) of the Social Se-
curity Act (42 U.S.C. 1396r–8(d)) is amended by adding 
at the end the following new paragraph: 
‘‘(8) RESTRICTIONS RELATING TO OPIOIDS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), with respect to calendar quarters be-
ginning on or after January 1, 2019, a State 
may only provide coverage under the State plan 
(or a waiver of such plan) for an opioid dis-
pensed to an individual enrolled under the plan 
(or waiver) to the extent that— 
‘‘(i) in the case of an initial prescrip-
tion for the opioid to the individual, such 
prescription is limited to a maximum of a 
7-day supply; and 
‘‘(ii) in the case of a refill of such pre-
scription, such refill is limited to a max-
imum of a 30-day supply and prescribed 
only if a provider— 
‘‘(I) determines that the expected 
benefits of using the opioid to treat or 
improve the individual’s pain or func-
tion, respectively, outweigh the risks 
of such use; 
VerDate Sep 11 2014 
05:14 May 05, 2018
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5635.IH
H5635
lotter on DSKBCFDHB2PROD with BILLS
‘‘(II) to the extent appropriate, 
combines the use of the opioid with 
non-pharmacologic therapy and non- 
opioid pharmacologic therapy; 
‘‘(III) establishes treatment goals 
for the individual and takes steps to 
ensure that the use of the opioid will 
be discontinued if the provider deter-
mines that the benefits of such use no 
longer outweigh the risks; and 
‘‘(IV) discusses with the indi-
vidual the known risks of such use, 
the realistic benefits of such use, and 
the responsibilities of the provider and 
individual in managing such use. 
‘‘(B) 
EXCEPTION.—Subparagraph 
(A) 
shall not apply with respect to opioids dispensed 
to individuals who are— 
‘‘(i) receiving treatment for cancer; 
‘‘(ii) receiving hospice or palliative 
care; or 
‘‘(iii) patients in a long-term care fa-
cility or a skilled nursing facility. 
‘‘(C) DEFINITIONS.—In this paragraph: 
VerDate Sep 11 2014 
05:14 May 05, 2018
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5635.IH
H5635
lotter on DSKBCFDHB2PROD with BILLS
‘‘(i) 
INITIAL
PRESCRIPTION.—The 
term ‘initial prescription’, with respect to 
an individual, includes the issuance of a 
new prescription to the individual for an 
opioid that the individual was previously 
prescribed, provided that such new pre-
scription is issued more than 60 days after 
the expiration of such previous prescrip-
tion. 
‘‘(ii) OPIOID.—The term ‘opioid’ has 
the meaning given such term in section 
102 of the Controlled Substances Act (21 
U.S.C. 802) and includes drugs included in 
schedules II, III, and IV of section 202(c) 
of such Act (21 U.S.C. 812(c)).’’. 
(b) PROHIBITION
ON
PAYMENTS
FOR
CERTAIN 
OPIOID PRESCRIPTIONS.—Section 1903(i) of the Social 
Security Act (42 U.S.C. 1396b(i)) is amended by inserting 
after paragraph (8) the following new paragraph: 
‘‘(9) with respect to opioids (as defined in sec-
tion 1927(d)(8)) dispensed in calendar quarters be-
ginning on or after January 1, 2019, unless such 
opioids are dispensed in accordance with section 
1927(d)(8); or’’. 
Æ 
VerDate Sep 11 2014 
05:14 May 05, 2018
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6301
E:\BILLS\H5635.IH
H5635
lotter on DSKBCFDHB2PROD with BILLS