H.R. 4063, Jason Simcakoski PROMISE Act

H.R. 4063

Jason Simcakoski PROMISE Act

May 10, 2016 (114th Congress, 2nd Session)

Staff Contact
Molly Newell

Floor Situation

 On Tuesday, May 10, 2016, the House will consider H.R. 4063, the Jason Simcakoski PROMISE Act, under suspension of the rules. The bill was introduced on November 18, 2015, by Rep. Bilirakis (R-FL) and was referred to the Committee on Veterans’ Affairs and the Committee on Armed Services. The Veterans’ Affairs Committee ordered the bill reported, in the Nature of a Substitute, on February 25, 2016 by voice vote.

Bill Summary

H.R. 4063 would improve the use of opioid therapy and pain management in treating veterans. Major provisions include:

  • requiring the Secretary of Veteran Affairs (VA) and the Secretary of Defense to update the Clinical Practice Guidelines on the management of opioid therapy for chronic pain and strengthening the focus of the Joint Pain Mangement Work Group of these two departments;
  • improving VA’s opioid safety measures by expanding the Opioid Safety Initative, increasing education and training on pain management and safe opioid prescribing practices, and requiring directors of each medical facility designate a pain management team of health care professionals responsible for coordinating and overseeing pain management therapy at the facility;
  • maximizing the availability of FDA approved opioid receptor antagonists for at-risk veterans and equipping each VA pharmacy with opioid receptor antagonists to be given to outpatients as needed;
  • requiring VA to disclose certain information to State Controlled Substance Monitoring Programs; and
  • requiring the Comptroller General to report on the VA Opioid Safety Initiative and the opioid prescribing practices of VA providers and to make recommendations on improvements.


Prescription drug abuse has been described as an epidemic, with an estimated 6.5 million current prescription drug abusers—including 4.3 million abusing prescription pain relievers (opioids). On average, 44 people die from an overdose of a prescription painkiller each day in the United States.[1]

Roughly 30 percent of adults in the U.S. experience chronic pain. However, for the veteran population this number is much higher with 50 to 60 percent of veteran patients living with chronic pain.[2] And, the death rate from opiate overdose among veteran patients is nearly double the national average.[3]

According to the bill sponsor, “The tragic death of Marine Corp. Veteran Jason Simcakoski in the Tomah, Wisconsin VA Medical Facility prompted the need for Congressional action. This August, nearly one year from Jason’s death, the Office of Inspector General released a report that concluded Jason’s cause of death was due to mixed drug toxicity and the combination of various medications was the plausible mechanism of action for a fatal outcome…This legislation will further my efforts to help our Veterans receive the quality care they have earned. My PROMISE Act will provide our Veterans safer, more personalized care to deal with the physical and mental wounds they are facing and will help improve efficiency at the VA.”[4]

[1] See CRS Report, “Prescript ion Drug Abuse,” Feb. 23,2016.
[2] See House Committee on Veterans’ Affairs Testimony
[3] See PBS Newshour, “VA’s opiate overload feeds veterans’ additctions, leading to overdose deaths,” Oct. 3, 2013.
[4] See Rep. Bilikrakis Press Release, “Bilirakis Introduces PROMISE Act to Help Veterans,” November 18, 2015.


The Congressional Budget Office (CBO) estimates that implementing H.R. 4063 would cost $138 million over the 2017-2021 period, subject to appropriation of the necessary amounts.Pay-as-you-go procedures do not apply because enacting the legislation would not affect direct spending or revenues. CBO estimates that enacting H.R. 4063 would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2027.

Additional Information

For questions or further information please contact Molly Newell with the House Republican Policy Committee by email or at 21374.