House Passes Permanent Buprenorphine Waiver Program for PAs

Legislation Passed June 22

July 2, 2018

On Friday, June 22, 2018, the U.S. House of Representatives passed legislation that will permanently extend the waiver program that allows PAs to prescribe buprenorphine for treatment of opioid use disorder (OUD).

H.R. 6, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018, is a bipartisan legislative package that was negotiated between Republican and Democratic leadership of the House Committee on Energy and Commerce and the House Committee on Ways and Means. This legislation passed, on a bipartisan vote of 396-14.

The Comprehensive Addiction and Recovery Act (CARA) of 2016 allowed PAs and NPs to obtain a Drug Enforcement Agency (DEA) waiver to prescribe buprenorphine for the purpose of providing medication-assisted treatment (MAT) for OUD as part of a five-year pilot program. This pilot program allows PAs to treat up to 30 patients during their first year with a waiver, with the option to apply to move to treating up to 100 patients after one year of being waivered. Currently, over 1,400 PAs have gone through the required training and received a waiver, allowing them to provide much-needed treatment to those suffering from OUD.

The SUPPORT Act would make the authorization for this waiver program permanent. It will also allow PAs who practice in a qualified setting, to immediately being treating up to 100 patients at a time with MAT. H.R. 6 also includes PAs in a new loan forgiveness program for addiction care providers in rural areas. This legislation would also further expand the list of providers eligible to prescribe buprenorphine by creating a five-year pilot program for certified nurse-midwives, clinical nurse specialists, and nurse anesthetists to receive a waiver.

The PA-friendly provisions in H.R. 6 are modeled off those contained in H.R. 3692, the Addiction Treatment Access Improvement Act. This legislation was championed by Representatives Paul Tonko (D-NY) and Ben Ray Lujan (D-NM) in the House of Representatives. There is also a companion bill in the Senate, S. 2317, championed by Senators Edward Markey (D-MA), Rand Paul (R-KY), Maggie Hassan (D-NH), and Susan Collins (R-ME). AAPA has advocated extensively in favor of both of these bills.

While passage of H.R. 6 through the House of Representatives represents a significant step forward, this legislation still needs to pass the Senate and be signed by the President before these PA-positive provisions become law.

All PAs are encouraged to contact their Senators and urge them to enact comprehensive opioid legislation that includes provisions making the buprenorphine waiver permanent and strengthening the role of PAs in addressing the epidemic.  Go to AAPA’s Advocacy Action Center to take action today.