WASHINGTON, D.C. – Sen. Sherrod Brown (D-OH), along with Sens. Pat Toomey (R-PA), Rob Portman (R-OH) and Tim Kaine (D-VA) have introduced a bill, Stopping Medication Abuse and Protecting Seniors Act, to prevent inappropriate access to opioids and improve patient care for at-risk beneficiaries.
“Americans all across the country have been affected by the growing public health crisis caused by addiction to opioids and other prescription drugs,” Brown said. “We should be doing more to help rehabilitate Ohioans who are suffering from drug addiction. This bill will help protect Medicare for future generations through better monitoring of prescription patterns on the part of doctors, pharmacies, and patients. By identifying those seniors who may be struggling with addiction, we can do more to help them recover. And by identifying bad actors who are fueling the prescription drug abuse epidemic by defrauding Medicare, we can help protect American taxpayers. It’s time to put an end to doctor shopping and pharmacy hopping.”
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.
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.
Brown unveiled the bipartisan legislation during a press conference at the Benjamin Rose Institute on Aging today in Cleveland. He joined Rich Browdie, President & CEO, Benjamin Rose Institute on Aging, and Dennis Michelson, of Painsville, who became addicted to prescription opiates after seeking medical help for prescription migraines.
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.