H.R. 4586 would allow the Centers for Disease Control and Prevention (CDC) to provide grants to states to enable and encourage pharmacies to dispense medications that reverse opioid overdoses pursuant to a standing order. A standing order is a prescription that permits another person to acquire, dispense, or administer medication without the prescription specifying who will be treated with the medication. The grants would be limited to $500,000 per state. The bill also would allow states to use the grant funds to implement best practices and to develop training materials on the purpose, administration, and availability of those medications. H.R. 4586 would authorize the appropriation of a total of $5 million of fiscal years 2017 through 2019 to carry out these activities. Assuming the availability of appropriated funds, CBO estimates those funds would be spent over the 2107-2021 period.
Under current law, an authorization of appropriations totaling $138 million exists for 2017 for CDC for activities related to bioterrorism and public health emergencies. H.R. 4586 would reduce the amount authorized by $5 million in 2017. Assuming appropriation actions consistent with the bill, CBO estimates that implementing this provision would result in $5 million less in discretionary outlays for that program over the 2017-2021 period.
On net, CBO estimates that implementing H.R. 4586 would not affect discretionary costs over the 2017-2021 period. Enacting H.R. 4586 would not affect direct spending or revenues; therefore, pay-as-you-go procedures do not apply. CBO estimates that enacting H.R. 4586 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2027.
H.R. 4586 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act. Any costs incurred by states that apply for grants authorized by the bill would be incurred voluntarily as a condition of assistance.