H.R. 4981 would permit nurse practitioners and physician assistants who meet certain criteria to apply for waivers administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). Those waivers would allow them to prescribe buprenorphine products to patients with opioid dependency. Additionally, the bill would permit pharmacists to fill only part of a prescription for certain drugs upon the request of the prescribing physician or the patient.
CBO estimates that enacting H.R. 4981 would reduce net direct spending by $37 million over the 2017-2026 period. Section 3 of the bill would increase direct spending by $85 million, while section 5 would decrease direct spending by $122 million. H.R. 4981 also would have a discretionary cost of about $2 million; any such spending would be subject to the availability of appropriated funds. Pay-as-you-go procedures apply because enacting the legislation would affect direct spending. H.R. 4981 would not affect revenues.
CBO estimates that enacting the legislation would not increase net direct spending or on-budget deficits by more than $5 billion in any of the four consecutive 10-year periods beginning in 2027.
H.R. 4981 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would impose no costs on state, local, or tribal governments. CBO estimates that some provisions of the bill would result in additional spending and other provisions would yield savings for states. CBO estimates that the net change in overall spending for states would be minimal over the 2017-2026 period.