ANA and other associations representing advanced practice registered nurses (APRNs) have been lobbying for years to make permanent the authority for nurse practitioners (NP) to prescribe medication-assisted treatments (MAT) for opioid-addicted patients and to extend the authority to the other three APRN specialties. The latest Senate package does not include this policy. ANA government affairs staff has been informed there are Senators with “holds” on this package meaning it can’t move forward until there are more negotiations. While we are disappointed the package does not currently include this provision, we still have several more bites at the apple.
The Comprehensive Addiction and Recovery Act of 2016 (Public Law No: 114-198.), commonly referred to as CARA, included a provision that allowed NPs and Physician Assistants (PAs) to take 24 hours of training to prescribe MAT for opioid-addicted patients. (This is referred to as “DATA 2000 waved” or just “DATA waved” authority.) This prescribing authority sunsets in 2021. The reason the prescribing authority is set to expire in 2021 was developed as a budgeting gimmick by Congress to keep the overall projected cost associated with CARA low. This provision was never intended to be a demonstration project – it was because Congress couldn’t find a way to offset the projected cost for permanent prescribing authority.
In June, the U.S. House of Representatives passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (H.R. 6), or the “SUPPORT for Patients and Communities Act” for short. Section 3003 of this bill has an agreed upon compromise version of what we have been lobbying for. It permanently extends the MAT prescribing authority for NPs and PAs and allows the other three APRN specialties the authority for five years. It also instructs the Department of Health and Human Services to conduct a study on the efficacy of prescribing MAT, and possible associated narcotics diversion issues, on all providers, including physicians. This would give the opportunity to for us to have data showing how important it is to have more access points for patients and that APRNs are just as qualified to treat opioid substance use disorder as physicians.
While this latest development is disappointing, it’s not over. Both the House and the Senate need to come together to pass identical legislation before any of this is signed into law. We have a large coalition of bipartisan legislators in the House and Senate who all agree that this is good policy. The current disagreement is over how to offset the projected cost estimated by the Congressional Budget Office (CBO). The ANA, along with the other associations representing APRNs, are on top of this issue and will be fighting for the inclusion of Section 3003 into any final package. It’s not over.
Further Reading
The CBO’s scoring rules for determining the cost of legislation are very complicated, convoluted, and don’t always make logical sense. The U.S. Drug Enforcement Agency (DEA) isn’t held to CBO’s scoring rules, and in January 2018, published an economic impact study on CARA. They found that from when the DATA 2000 waiver began through February 21, 2017, there were 33,663 DATA-waived physicians compared to 1,247,716 total physicians. Since February 2017, when NPs could first obtain the DATA 2000 waiver until May 5, 2018, 5,649 NPs have obtained a DATA 2000 waiver compared to 248,000 total NPs. That means proportionately, in less than two years, NPs have received almost as many waivers as physicians received in 17 years (2.3 percent of NPs v. 2.7 percent of physicians).
The DEA estimates that the total economic burden of the opioid epidemic is $75.7 billion, which amounts to $41,000 per patient. They also estimate that the net economic benefit of authorizing NPs and PAs to provide MAT, primarily due to increased labor productivity and decreased healthcare and legal costs, will be $640-729 million dollars over five years. Based on the DEA’s estimate that 5,235 NPs and PAs would obtain the waiver, this amounts to an average costs savings of approximately $122,254-139,255 for every NP or PA obtaining the waiver.
ANA strongly believes that extending the prescribing authority to the other APRN specialties will only further the success of this policy. ANA advocates for all RNs and APRNs to practice to the full extent of their education and practice authority, allowing individualized treatment plans for all patients and increased access to health care services, including MAT.
For additional information or comments, please contact Sam Hewitt, ANA’s senior associate director for federal government relations at Samuel.hewitt@ana.org