Title: Responsible Opioid Prescription Act
Policy area: Health

Summary:
Responsible Opioid Prescription Act
This bill limits Medicaid coverage of opioids prescribed to enrollees other than those who are in long-term care facilities or who are receiving hospice care, palliative care, or treatment for cancer.


[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5635 Introduced in House (IH)]

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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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Responsible Opioid Prescription 
Act''.

SEC. 2. MEDICAID RESTRICTIONS RELATING TO OPIOID PRESCRIPTIONS.

    (a) In General.--Section 1927(d) of the Social Security 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 subparagraph (B), 
                with respect to calendar quarters beginning 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 dispensed to an individual enrolled under the 
                plan (or waiver) to the extent that--
                            ``(i) in the case of an initial 
                        prescription 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 
                        prescription, such refill is limited to a 
                        maximum 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 
                                function, respectively, outweigh the 
                                risks of such use;
                                    ``(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 
                                determines that the benefits of such 
                                use no longer outweigh the risks; and
                                    ``(IV) discusses with the 
                                individual 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 
                        facility or a skilled nursing facility.
                    ``(C) Definitions.--In this paragraph:
                            ``(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 prescription is issued 
                        more than 60 days after the expiration of such 
                        previous prescription.
                            ``(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 section 
        1927(d)(8)) dispensed in calendar quarters beginning on or 
        after January 1, 2019, unless such opioids are dispensed in 
        accordance with section 1927(d)(8); or''.
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