May 29, 2018

The Honorable Gus Bilirakis

United States House of Representatives
2112 Rayburn House Office Building
Washington, D.C. 20515

Dear Representative Bilirakis:

PPSC USA, LLC is the voice for Florida’s small business, independently owned pharmacies at the state
and national level. We are actively involved in pharmacy and patient related policies throughout the
United States.

As you can imagine, many of our community pharmacies throughout Florida are concerned about
Florida’s opioid epidemic. Our pharmacy owners and pharmacists want to be able to provide more for
their patients to ensure appropriate pain management does not lead to chronic addiction and increased
potential for overdose. We believe all patients should be provided with protections and options to assist
with those risks.

We know Congress is discussing multiple bill to address the opioid crisis, and we encourage expanding
comprehensive access to naloxone to help save lives and money.

According to the U.S. Department of Health and Human Services, studies show the opioid epidemic has
a disproportionate impact on Medicaid beneficiaries. They are prescribed painkillers at twice the rate of
non-Medicaid patients and are up to six times the risk for overdosing. Additionally, the inspector general
reported that 90,000 Medicare beneficiaries are at serious risk for opioid misuse or overdose.

Providing naloxone prescriptions to certain CDC approved Medicaid and Medicare beneficiaries will help
in multiple ways. It will allow for our pharmacy owners and pharmacists to distribute appropriate
prescriptions for opioid medications alongside an overdose reversing agent, encouraging the prevention
of a deadly overdose. A patients’ body mass index cannot predict dosage levels, so when it comes to
opioid use, patients’ tolerance levels are not an exact science. With the provision of naloxone with
opioids we are arming patients or their caregivers with the best opportunity for protection from an
accidental overdose.

Additionally, there are cost savings associated with providing naloxone alongside opioid prescriptions,
because it means less visits to a trauma center or emergency room. In 2014, up to 68 percent of opioid
related hospitalizations were paid for by Medicaid or Medicare. An NIH study conducted in 2016
indicated that patients who received naloxone prescriptions had 47 percent fewer visits per month in six
months and 63 percent fewer visits after one year compared to patients who had not received
naloxone.

This is a tough issue to tackle, however providing Medicaid and Medicare patients with naloxone is a no
brainer that help protect patients from an opioid overdose. We are happy to be a resource for you
throughout your deliberations, and we look forward to further protecting Floridians from this terrible
epidemic.

Regards,

Bill Mincy
Vice President, PPSC