House Passes Legislation Eliminating the X-Waiver and Adding PBM Transparency Requirements

Today, the United States House of Representatives passed the Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R. 7666), which included the ASHP-supported Mainstreaming Addiction Treatment Act. The legislation would eliminate the need for clinicians to apply for an X-waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA) to administer medications for opioid use disorder (MOUD). Under the new law, clinicians would still be required to complete eight hours of training but would not need to apply for a separate waiver. This removes a major barrier for pharmacists, who were previously ineligible for X-waivers, regardless of education. Elimination of the X-waiver requirement to order MOUDs is a long-standing ASHP priority.

"Patients' need for MOUD treatment continues to significantly outstrip availability, so we are pleased that policymakers are taking steps to remove barriers that prevented pharmacists from fully engaging in these critical services," said Tom Kraus, ASHP vice president of government relations.

H.R. 7666 also creates transparency requirements for pharmacy benefit managers (PBMs). Specifically, PBMs will be required to disclose copayment assistance dollars received, dispensing data on each covered drug (including the drug's wholesale acquisition cost and the total out-of-pocket spending on each drug for plan beneficiaries), as well as information on drug rebates and fees received by the plan.

These transparency requirements have been supported by the Get The Medications Right (GTMRx) Institute, of which ASHP is a founding board member. The GTMRx Employer Toolkit (developed by GTMRx, along with 10 of the nation's largest employer business coalitions) offers guidance on health benefit plan design as employers contract with PBMs.

The bill will now advance to the Senate for consideration. ASHP will update members on the progress of the legislation and will continue to advocate for its passage.