Update on S.4429 – Substance Use Prevention and Pharmacy Oriented Recovery Treatment Prescription Act (SUPPORT Rx Act)

Over the past year, ACCP’s Government Affairs team in Washington, D.C., has been working with the office of Sen. Cory Booker (D-NJ) to develop and advance legislation that would fund a 3-year pilot project to award grants to eligible entities to establish, maintain, or improve a pharmacy-based addiction care program. The legislation’s official title is S.4429, Substance Use Prevention and Pharmacy Oriented Recovery Treatment Prescription Act (SUPPORT Rx Act).

It is unlikely that S.4429 will be included in the final, year-end legislation that closes out this session of Congress. However, it is hoped that Senator Booker will reintroduce the bill as the new Congress gets underway in 2025, and it’s important that ACCP members tell their senators to support this important legislative initiative.

Specifically, the legislation requires the Secretary of the Department of Health & Human Services (HHS) to initiate a 3-year demonstration program that awards grants to eligible entities to establish, maintain, or improve a pharmacy-based addiction care program.

Eligible Entities

Eligible entities might include:

• a state, tribal, or local health department
• a partnership between such a health department and one or more other entities, the state laws of which allow pharmacists to prescribe, or enter into collaborative practice agreements with physicians authorized to prescribe
• a specialty addiction treatment practitioner in a primary care setting or a specialty substance use disorder treatment facility

Funding

The legislation identifies a funding mechanism through an established Harm Reduction Grant Program of the Substance Abuse and Mental Health Services Administration (SAMHSA).

Program Guidelines

The legislation sets out that the SAMHSA funding can be used to:

• establish, maintain, or improve a comprehensive, pharmacy-based addiction care program to support withdrawal, induction, ongoing care, and rescue for individuals with opioid or other substance use disorders provided by and at community pharmacies
• offer a range of evidence-based medication treatments for opioid and other substance use disorders, including management of withdrawal from opioids and other substances, when appropriate; induction; and maintenance care
• render same-day care services of low-barrier treatment, with no or reduced requirements, including no or reduced requirements for payment, insurance, age limits, and identification
• provide harm reduction supplies to promote safety, such as opioid reversal medications approved by the FDA, naloxone training materials for staff, adulterant detection devices (including test strips), and other materials
• provide training for pharmacists on treating patients with opioid and other substance use disorders
• provide compensation to staff for pharmacy program and other program operations for which the staff would not otherwise receive compensation
• provide payment for an individual to obtain not more than a 30-day supply of medication prescribed at any one time under the pharmacy-based addiction care program supported by the grant
• provide care continuity fee payments to providers or clinics, the patients of which transfer their maintenance care to the pharmacy-based addiction care program supported by the grant to support good recordkeeping, safe transfer, and transition in care
• provide telebehavioral health services
• provide construction to permit private or semiprivate spaces for counseling and administration of medication
• provide secure technology that is in compliance with HIPAA privacy regulations
• establish a collaborative practice agreement
• pay for the costs of training staff in administration of opioid reversal medications
• pay for other necessary staff training
• pay for registration fees in each applicable state

Outcomes: Report to Congress

The legislation requires that HHS submit a report to Congress no later than 120 days after the end of the 3-year pilot project. To comply with this requirement, participating entities are required to submit to HHS:

• an annual evaluation of the progress of the pharmacy-based addiction care program supported by the grant, including information on:
  • number of patients receiving treatment
  • any changes in local rates of overdose over the course of the grant
  • cost data
  • patient-reported outcomes
  • overdose data
  • hospitalization data
  • quality and safety measures
  • program retention data
  • data on the opioid prescription fill rates
  • demographic characteristics of patients who were treated by the program
  • any other information the Secretary determines necessary

Background

A study from researchers at Brown University, Rhode Island Hospital, and the University of Rhode Island, published in the New England Journal of Medicine, documented the experiences of 100 patients who started taking buprenorphine after visiting a specialty trained pharmacist for their care. Once stabilized on the medication, 58 patients were randomly assigned to receive either continued care in the pharmacy or usual care in a clinic or physician’s office.

After 1 month, the patients in the pharmacy care group had dramatically higher rates of retention: 25 (89%) continued to receive treatment in the pharmacy compared with 5 (17%) in the usual care group.

Those who were prescribed treatment faced barriers such as long-distance travel to clinics, inconvenient clinic hours, time-consuming paperwork and bureaucracy, stigma, and more. Senator Booker’s legislation is aimed at addressing hurdles that are perceived as barriers to the widespread use of buprenorphine.