8/3/2015 3:26:00 PM
Washington, D.C. – Today, U.S. Senator Rob Portman (R-Ohio) joined U.S. Senators Pat Toomey (R-Pa.), Sherrod Brown (D-Ohio), and Tim Kaine (D-Va.) in working to help end the plague of prescription drug abuse.
The senators introduced the bipartisan Stopping Medication Abuse and Protecting Seniors Act to prevent inappropriate access to opioids and improve patient care for at-risk beneficiaries. This drug abuse prevention plan, already operating in Medicaid and commercial plans, identifies a beneficiary with a history of drug abuse in Medicare Part D and Medicare Advantage and locks the beneficiary into one prescriber and one pharmacy to reduce doctor and pharmacy shopping.
It would also encourage insurers, Part D plan sponsors, and physicians to assist beneficiaries battling addiction in seeking substance abuse treatment. The bipartisan legislation will save taxpayers between $79 and $115 million over 10 years by eliminating fraudulent and medically unnecessary prescription payments from Medicare.
“Our bill will protect those at risk of prescription drug abuse, while also maintaining patients’ rights,” Portman stated. “Additionally, it will save taxpayer dollars in the long-run by ensuring Medicare funds are being utilized by those who need it the most. I’m pleased to introduce this bill that not only has the potential to save lives, but also to reduce health care costs and maintain access to health care for seniors.”
The Government Accountability Office estimates 170,000 Medicare beneficiaries may be battling addiction to pain medication. As the rate of pain medication abuse and overdose continues to rise, this legislation would combat opiate abuse, while also improving the continuity of care, and ensuring patients with true medical needs maintain access to effective pain control. Both the HHS Office of the Inspector General and the Medicare Payment Advisory Commission have suggested Medicare adopt the kind of drug abuse prevention tool authorized by the legislation.
The Stopping Medication Abuse and Protecting Seniors Act would:
• Honor beneficiary preferences for preferred single pharmacy and preferred single provider unless it is determined that using those providers will contribute to continued drug abuse.
• Notify an at-risk beneficiary of their new status, and conduct a clinical review to ensure seniors who need high amounts of pain pills are not inappropriately included in the program.
• Direct HHS to establish clinical criteria for determining who is an at-risk beneficiary based on use of “frequently abused” opiates.
• Exempt beneficiaries receiving hospice care and those receiving care at a nursing home via a long-term care pharmacy.
• Allow for data sharing between CMS, plans, and contractors to address waste, fraud, and abuse.
• Direct the GAO to study concerns of prescription drug abuse beyond opiates within Medicare.
• Set up procedures to terminate an individual’s inclusion in lock-in and protect a beneficiary’s appeal rights.