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<dc:title>114 S483 RS: Ensuring Patient Access and Effective Drug Enforcement Act of 2015</dc:title>
<dc:publisher>U.S. Senate</dc:publisher>
<dc:date>2015-02-12</dc:date>
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<dc:language>EN</dc:language>
<dc:rights>Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.</dc:rights>
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<distribution-code display="yes">II</distribution-code><calendar>Calendar No. 368</calendar><congress>114th CONGRESS</congress><session>2d Session</session><legis-num>S. 483</legis-num><current-chamber>IN THE SENATE OF THE UNITED STATES</current-chamber><action><action-date date="20150212">February 12, 2015</action-date><action-desc><sponsor name-id="S118">Mr. Hatch</sponsor> (for himself, <cosponsor name-id="S316">Mr. Whitehouse</cosponsor>, <cosponsor name-id="S350">Mr. Rubio</cosponsor>, <cosponsor name-id="S299">Mr. Vitter</cosponsor>, and <cosponsor name-id="S373">Mr. Cassidy</cosponsor>) introduced the following bill; which was read twice and referred to the <committee-name added-display-style="italic" committee-id="SSJU00" deleted-display-style="strikethrough">Committee on the Judiciary</committee-name></action-desc></action><action stage="Reported-in-Senate"><action-date>February 11, 2016</action-date><action-desc>Reported by <sponsor name-id="S153">Mr. Grassley</sponsor>, with an amendment</action-desc><action-instruction>Strike out all after the enacting clause and insert the part printed in italic</action-instruction></action><legis-type>A BILL</legis-type><official-title>To improve enforcement efforts related to prescription drug diversion and abuse, and for other
			 purposes.</official-title></form>
	<legis-body id="H3D7856030F154CAB9CA7B3EE1120FC3D" style="OLC">
 <section changed="deleted" committee-id="SSJU00" id="H50C178AFA00F4508B6D6A6560D7B53ED" reported-display-style="strikethrough" section-type="section-one"><enum>1.</enum><header>Short title</header><text display-inline="no-display-inline">This Act may be cited as the <quote><short-title>Ensuring Patient Access and Effective Drug Enforcement Act of 2015</short-title></quote>.</text> </section><section changed="deleted" committee-id="SSJU00" id="HCE607419F1D34D6EB8A11EC312ECD226" reported-display-style="strikethrough"><enum>2.</enum><header>Registration process under Controlled Substances Act</header> <subsection id="H5306A535106842CEA7168B562BABAC6E"><enum>(a)</enum><header>Definitions</header> <paragraph id="H22FA1DC728154998BCE7EE52F234919D"><enum>(1)</enum><header>Factors as may be relevant to and consistent with the public health and safety</header><text>Section 303 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823</external-xref>) is amended by adding at the end the following:</text>
					<quoted-block changed="deleted" committee-id="SSJU00" display-inline="no-display-inline" id="H363843CE43714E49AB156F60AAB21DB1" reported-display-style="strikethrough" style="OLC">
 <subsection id="HC569CBA06D4C441EBBFAD425B60CF527"><enum>(i)</enum><text display-inline="yes-display-inline">In this section, the phrase <quote>factors as may be relevant to and consistent with the public health and safety</quote> means factors that are relevant to and consistent with the findings contained in section 101.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph><paragraph id="H900618BBCC944BB8BCC639DC372E5130"><enum>(2)</enum><header>Imminent danger to the public health or safety</header><text>Section 304(d) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/824">21 U.S.C. 824(d)</external-xref>) is amended—</text>
 <subparagraph id="HEFBB9A0247584D26BEC2EB0DCCD49C04"><enum>(A)</enum><text>by striking <quote>(d) The Attorney General</quote> and inserting <quote>(d)(1) The Attorney General</quote>; and</text> </subparagraph><subparagraph id="H4138CA7EE7C94012821D34183B7874E5"><enum>(B)</enum><text>by adding at the end the following:</text>
						<quoted-block changed="deleted" committee-id="SSJU00" display-inline="no-display-inline" id="HDEF025DDA7BA4A52B7C7F6B6761B987D" reported-display-style="strikethrough" style="OLC">
 <paragraph id="H7C924D2D4300454084F72F687BDFFECE" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">In this subsection, the phrase <term>imminent danger to the public health or safety</term> means that, in the absence of an immediate suspension order, controlled substances will continue to be distributed or dispensed by a registrant who knows or should know through fulfilling the obligations of the registrant under this Act—</text>
 <subparagraph id="idB02483A43EBB48CEA74AE9BD4EB5F683"><enum>(A)</enum><text>the dispensing is outside the usual course of professional practice;</text> </subparagraph><subparagraph id="id7F47C60A80FD4934A802C91D108492B8"><enum>(B)</enum><text>the distribution or dispensing poses a present or foreseeable risk of adverse health consequences or death due to the abuse or misuse of the controlled substances; or</text>
 </subparagraph><subparagraph id="id9F0A2C0302A4474BB99F6A6E5D7F53FE"><enum>(C)</enum><text>the controlled substances will continue to be diverted outside of legitimate distribution channels.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block> </subparagraph></paragraph></subsection><subsection id="H919D5C29D791499D832B0BC019DE76A9"><enum>(b)</enum><header>Opportunity To submit corrective action plan prior to revocation or suspension</header><text display-inline="yes-display-inline">Subsection (c) of section 304 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/824">21 U.S.C. 824</external-xref>) is amended—</text>
 <paragraph id="HF86ED9E88D30482C87DB31431C217892"><enum>(1)</enum><text>by striking the last two sentences;</text> </paragraph><paragraph id="H01F77CA56680471B96B9E7936C123503"><enum>(2)</enum><text>by striking <quote>(c) Before</quote> and inserting <quote>(c)(1) Before</quote>; and</text>
 </paragraph><paragraph id="H96F65A1C309343CEB8A271E50783F677"><enum>(3)</enum><text>by adding at the end the following:</text> <quoted-block changed="deleted" committee-id="SSJU00" display-inline="no-display-inline" id="H14A81C371A124B00B74C1BB759D2A90F" reported-display-style="strikethrough" style="OLC"> <paragraph id="H818C725CA32941F5AE4C7B4FF743064F" indent="up1"><enum>(2)</enum><text>An order to show cause under paragraph (1) shall—</text>
 <subparagraph id="H7DC04F26446D43BBA5C365797A994BA4"><enum>(A)</enum><text>contain a statement of the basis for the denial, revocation, or suspension, including specific citations to any laws or regulations alleged to be violated by the applicant or registrant;</text>
 </subparagraph><subparagraph id="H58F9BAD54DF947388CBCFC0074A7E79F"><enum>(B)</enum><text>direct the applicant or registrant to appear before the Attorney General at a time and place stated in the order, but not less than 30 days after the date of receipt of the order; and</text>
 </subparagraph><subparagraph id="H81EBEE957CBB4B5193ABFB19D42B4A03"><enum>(C)</enum><text>notify the applicant or registrant of the opportunity to submit a corrective action plan on or before the date of appearance.</text>
 </subparagraph></paragraph><paragraph id="HDDAEB68EE86C46EF846AD61851444FFE" indent="up1"><enum>(3)</enum><text>Upon review of any corrective action plan submitted by an applicant or registrant pursuant to paragraph (2), the Attorney General shall determine whether denial, revocation or suspension proceedings should be discontinued, or deferred for the purposes of modification, amendment, or clarification to such plan.</text>
 </paragraph><paragraph id="HC341FA78C8EC4E3CBB1E42489F7E23F6" indent="up1"><enum>(4)</enum><text>Proceedings to deny, revoke, or suspend shall be conducted pursuant to this section in accordance with subchapter II of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/5">chapter 5</external-xref> of title 5, United States Code. Such proceedings shall be independent of, and not in lieu of, criminal prosecutions or other proceedings under this title or any other law of the United States.</text>
 </paragraph><paragraph id="H36C826AE1CBE4AFE9602499F09552B68" indent="up1"><enum>(5)</enum><text>The requirements of this subsection shall not apply to the issuance of an immediate suspension order under subsection (d).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</paragraph></subsection></section><section changed="deleted" committee-id="SSJU00" id="HA72B90AD1F004BD59C5A71765787DF1B" reported-display-style="strikethrough"><enum>3.</enum><header>Report to Congress on effects of law enforcement activities on patient access to medications</header>
 <subsection id="HFD8E94DA3E174658B6776898F6C155B7"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Commissioner of Food and Drugs and the Director of the Centers for Disease Control and Prevention, in coordination with the Administrator of the Drug Enforcement Administration and in consultation with the Secretary of Defense and the Secretary of Veterans Affairs, shall submit a report to the Committee on the Judiciary of the House of Representatives, the Committee on Energy and Commerce of the House of Representatives, the Committee on the Judiciary of the Senate, and the Committee on Health, Education, Labor, and Pensions of the Senate identifying—</text>
 <paragraph id="HD2C44B04DD6A410D90EAD7172EA7BEFB"><enum>(1)</enum><text>obstacles to legitimate patient access to controlled substances;</text> </paragraph><paragraph id="H2BC13C38B23E48C98ADC53AE2A19F530"><enum>(2)</enum><text>issues with diversion of controlled substances; and</text>
 </paragraph><paragraph id="H21717A3FD57A44448BD166B441E02C96"><enum>(3)</enum><text>how collaboration between Federal, State, local, and tribal law enforcement agencies and the pharmaceutical industry can benefit patients and prevent diversion and abuse of controlled substances.</text>
 </paragraph></subsection><subsection id="H7DED1A4A89A7442EA504E8EC24DF85E9"><enum>(b)</enum><header>Consultation</header><text display-inline="yes-display-inline">The report under subsection (a) shall incorporate feedback and recommendations from the following:</text> <paragraph id="H092E27C086584A9FB8D1B652B975F6FD"><enum>(1)</enum><text>Patient groups.</text>
 </paragraph><paragraph id="H5CD65F75C12849BDA6D28D3B4B888192"><enum>(2)</enum><text>Pharmacies.</text> </paragraph><paragraph id="H9469E001598C4B808B8554CF74A3EAE5"><enum>(3)</enum><text>Drug manufacturers.</text>
 </paragraph><paragraph id="H4C1B8E43FFE643FE9E5FAFB80C1C3D6B"><enum>(4)</enum><text>Common or contract carriers and warehousemen.</text> </paragraph><paragraph id="HECACCE814CF34A90AD1D19D19CAA8931"><enum>(5)</enum><text>Hospitals, physicians, and other health care providers.</text>
 </paragraph><paragraph id="HA5BEFFAC62054C27B0C0FFC7FA48F57C"><enum>(6)</enum><text>State attorneys general.</text> </paragraph><paragraph id="H44FB8066A4584465AEAB20596F6A349C"><enum>(7)</enum><text display-inline="yes-display-inline">Federal, State, local, and tribal law enforcement agencies.</text>
 </paragraph><paragraph id="HBF1D70DCC8A34E7098D1B9295EF8D2CF"><enum>(8)</enum><text>Health insurance providers and entities that provide pharmacy benefit management services on behalf of a health insurance provider.</text>
 </paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF98C2C07D6FB4FB9A1007FC08F5C1729"><enum>(9)</enum><text>Wholesale drug distributors.</text> </paragraph><paragraph commented="no" display-inline="no-display-inline" id="id2A7957D1E6BF41C79F1D3510BA5D3445"><enum>(10)</enum><text>Veterinarians.</text></paragraph></subsection></section></legis-body>
	<legis-body display-enacting-clause="no-display-enacting-clause">
 <section changed="added" committee-id="SSJU00" id="idcb24991a-4621-4084-afad-e98100aa14d6" reported-display-style="italic" section-type="section-one"><enum>1.</enum><header>Short title</header><text display-inline="no-display-inline">This Act may be cited as the <quote><short-title>Ensuring Patient Access and Effective Drug Enforcement Act of 2016</short-title></quote>.</text> </section><section changed="added" committee-id="SSJU00" id="idb52ae63c-cc9c-479b-9608-b3435e826287" reported-display-style="italic"><enum>2.</enum><header>Registration process under Controlled Substances Act</header> <subsection id="iddb1fbb75-3689-44b4-a84b-8774a8807f2c"><enum>(a)</enum><header>Definitions</header> <paragraph id="id305f3d36-63b7-4b86-8217-77072dcf699e"><enum>(1)</enum><header>Factors as may be relevant to and consistent with the public health and safety</header><text>Section 303 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/823">21 U.S.C. 823</external-xref>) is amended by adding at the end the following:</text>
					<quoted-block changed="added" committee-id="SSJU00" display-inline="no-display-inline" id="idb94ba81b-8dd6-4fb8-828c-2be8acd03e05" reported-display-style="italic" style="OLC">
 <subsection id="id91a5d7dd-56f8-4175-9e5b-32ffc483aa35"><enum>(j)</enum><text display-inline="yes-display-inline">In this section, the phrase <quote>factors as may be relevant to and consistent with the public health and safety</quote> means factors that are relevant to and consistent with the findings contained in section 101.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph><paragraph id="ida27fb7fd-c666-46aa-888d-b0c7a7badde0"><enum>(2)</enum><header>Imminent danger to the public health or safety</header><text>Section 304(d) of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/824">21 U.S.C. 824(d)</external-xref>) is amended—</text>
 <subparagraph id="id10165f51-2aff-4e7c-b38d-c50fbd56221d"><enum>(A)</enum><text>by striking <quote>(d) The Attorney General</quote> and inserting <quote>(d)(1) The Attorney General</quote>; and</text> </subparagraph><subparagraph id="id9c06cbbc-7eb3-4212-9ba4-06961221e251"><enum>(B)</enum><text>by adding at the end the following:</text>
						<quoted-block changed="added" committee-id="SSJU00" display-inline="no-display-inline" id="idE641FF86805E40D8AC331C9824CE20B9" reported-display-style="italic" style="OLC">
 <paragraph id="idbfcef58f-98d5-459b-a5b6-97c7a2db1fb9" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">In this subsection, the phrase <term>imminent danger to the public health or safety</term> means that, due to the failure of the registrant to maintain effective controls against diversion or otherwise comply with the obligations of a registrant under this title or title III, there is a substantial likelihood of an immediate threat that death, serious bodily harm, or abuse of a controlled substance will occur in the absence of an immediate suspension of the registration.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
 </subparagraph></paragraph></subsection><subsection id="idd93a504a-7d5e-42ca-a2bc-7ff513ff485a"><enum>(b)</enum><header>Opportunity To submit corrective action plan prior to revocation or suspension</header><text display-inline="yes-display-inline">Subsection (c) of section 304 of the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/824">21 U.S.C. 824</external-xref>) is amended—</text> <paragraph id="ida68e2497-3c87-47fb-8c4e-65f19cf3bad5"><enum>(1)</enum><text>by striking the last three sentences;</text>
 </paragraph><paragraph id="id3264ec31-3bfa-4c96-a05f-b650181cafe5"><enum>(2)</enum><text>by striking <quote>(c) Before</quote> and inserting <quote>(c)(1) Before</quote>; and</text> </paragraph><paragraph id="id389db68f-e3a9-40dd-921d-9680ea5d41ea"><enum>(3)</enum><text>by adding at the end the following:</text>
					<quoted-block changed="added" committee-id="SSJU00" display-inline="no-display-inline" id="id2bd77c1c-ee67-47e6-a4dd-7638d4790151" reported-display-style="italic" style="OLC">
 <paragraph id="id4a50561a-e8e0-46d2-929a-3d4b9b97d79d" indent="up1"><enum>(2)</enum><text>An order to show cause under paragraph (1) shall—</text> <subparagraph id="idbdfb6220-a85f-4283-908e-d8267dc6733f"><enum>(A)</enum><text>contain a statement of the basis for the denial, revocation, or suspension, including specific citations to any laws or regulations alleged to be violated by the applicant or registrant;</text>
 </subparagraph><subparagraph id="idedda3c01-94d1-4330-8eed-b3c28525b9f3"><enum>(B)</enum><text>direct the applicant or registrant to appear before the Attorney General at a time and place stated in the order, but not less than 30 days after the date of receipt of the order; and</text>
 </subparagraph><subparagraph id="id9a5e21ef-9e2e-475e-8830-7a7030197b65"><enum>(C)</enum><text>notify the applicant or registrant of the opportunity to submit a corrective action plan on or before the date of appearance.</text>
 </subparagraph></paragraph><paragraph id="id74449e38-1fa3-4c8f-a505-297643a9300f" indent="up1"><enum>(3)</enum><text>Upon review of any corrective action plan submitted by an applicant or registrant pursuant to paragraph (2), the Attorney General shall determine whether denial, revocation, or suspension proceedings should be discontinued, or deferred for the purposes of modification, amendment, or clarification to such plan.</text>
 </paragraph><paragraph id="idc8942f97-6e37-4421-b288-d908da548617" indent="up1"><enum>(4)</enum><text>Proceedings to deny, revoke, or suspend shall be conducted pursuant to this section in accordance with subchapter II of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/5">chapter 5</external-xref> of title 5, United States Code. Such proceedings shall be independent of, and not in lieu of, criminal prosecutions or other proceedings under this title or any other law of the United States.</text>
 </paragraph><paragraph id="id28a439eb-2cdb-4b9f-bc46-09e4dd02b13f" indent="up1"><enum>(5)</enum><text>The requirements of this subsection shall not apply to the issuance of an immediate suspension order under subsection (d).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</paragraph></subsection></section><section changed="added" committee-id="SSJU00" id="id907952cd-9a96-41ba-9df7-8d09a97c08b6" reported-display-style="italic"><enum>3.</enum><header>Report to Congress</header>
 <subsection id="idd4845fdc-2eec-401d-9b36-a51f34c714bc"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Commissioner of Food and Drugs, the Administrator of the Substance Abuse and Mental Health Services Administration, the Director of the Agency for Healthcare Research and Quality, and the Director of the Centers for Disease Control and Prevention, in coordination with the Administrator of the Drug Enforcement Administration and in consultation with the Secretary of Defense and the Secretary of Veterans Affairs, shall submit a report to the Committee on the Judiciary of the House of Representatives, the Committee on Energy and Commerce of the House of Representatives, the Committee on the Judiciary of the Senate, and the Committee on Health, Education, Labor, and Pensions of the Senate identifying—</text>
 <paragraph id="id0cc36c54-f53e-44aa-b58a-3972235d6e8c"><enum>(1)</enum><text>obstacles to legitimate patient access to controlled substances;</text> </paragraph><paragraph id="id988b68bf-b67c-470a-b7e6-556a38b0a110"><enum>(2)</enum><text>issues with diversion of controlled substances;</text>
 </paragraph><paragraph id="id92ead453-984a-4556-ab8e-abafaf87b11d"><enum>(3)</enum><text>how collaboration between Federal, State, local, and tribal law enforcement agencies and the pharmaceutical industry can benefit patients and prevent diversion and abuse of controlled substances;</text>
 </paragraph><paragraph id="id4EE8D507EC9F4946B0B48FC84DC57893"><enum>(4)</enum><text>the availability of medical education, training opportunities, and comprehensive clinical guidance for pain management and opioid prescribing, and any gaps that should be addressed;</text>
 </paragraph><paragraph id="id774b10f90e814240b94196e742ca2548"><enum>(5)</enum><text>beneficial enhancements to State prescription drug monitoring programs, including enhancements to require comprehensive prescriber input and to expand access to the programs for appropriate authorized users; and</text>
 </paragraph><paragraph id="id485a858782084ad7906c07e092e5df4f"><enum>(6)</enum><text>steps to improve reporting requirements so that the public and Congress have more information regarding prescription opioids, such as the volume and formulation of prescription opioids prescribed annually, the dispensing of such prescription opioids, and outliers and trends within large data sets.</text>
 </paragraph></subsection><subsection id="ide6cc7c3c-109f-49c6-9e50-c86974d6e402"><enum>(b)</enum><header>Consultation</header><text display-inline="yes-display-inline">The report under subsection (a) shall incorporate feedback and recommendations from the following:</text> <paragraph id="id3ba38ca6-05e0-40c0-98d9-bf54463f5766"><enum>(1)</enum><text>Patient groups.</text>
 </paragraph><paragraph id="idf050c1c2-12bb-4df7-94a2-9f98e8ac581e"><enum>(2)</enum><text>Pharmacies.</text> </paragraph><paragraph id="id1f15eba2-e7de-4f4f-a923-9182f108aac6"><enum>(3)</enum><text>Drug manufacturers.</text>
 </paragraph><paragraph id="id446f50af-6dc1-4f20-bbb5-ae3f25f30c9e"><enum>(4)</enum><text>Common or contract carriers and warehousemen.</text> </paragraph><paragraph id="id2be64043-4ce9-4cac-9faf-50e8fb8c9287"><enum>(5)</enum><text>Hospitals, physicians, and other health care providers.</text>
 </paragraph><paragraph id="id249cd71e-27b9-4b9b-9938-943cb861ad13"><enum>(6)</enum><text>State attorneys general.</text> </paragraph><paragraph id="idf6b1c8d5-f12f-49aa-927b-1c662046e842"><enum>(7)</enum><text display-inline="yes-display-inline">Federal, State, local, and tribal law enforcement agencies.</text>
 </paragraph><paragraph id="id3bb699e0-b752-4d82-b8b3-fe023a236e07"><enum>(8)</enum><text>Health insurance providers and entities that provide pharmacy benefit management services on behalf of a health insurance provider.</text>
 </paragraph><paragraph commented="no" display-inline="no-display-inline" id="id77108299-ca07-4c01-a177-322e2dd37137"><enum>(9)</enum><text>Wholesale drug distributors.</text> </paragraph><paragraph commented="no" display-inline="no-display-inline" id="id75e13650-71a1-48e1-ad64-ff1df29b4edd"><enum>(10)</enum><text>Veterinarians.</text>
 </paragraph><paragraph id="id4440af92c9994f77a958a53e7f4115f0"><enum>(11)</enum><text>Professional medical societies and boards.</text> </paragraph><paragraph id="id5450aecd0b6843f39ac5c35589e16e50"><enum>(12)</enum><text>State and local public health authorities.</text>
 </paragraph><paragraph id="idd3eaa8a0c4cd405d8a651bfdcbdf233f"><enum>(13)</enum><text>Health services research organizations.</text></paragraph></subsection></section></legis-body><endorsement><action-date>February 11, 2016</action-date><action-desc>Reported with an amendment</action-desc></endorsement></bill> 

