Washington, D.C.—What if Medicare beneficiaries with a history of drug abuse were limited to using one pharmacy to fill narcotics prescriptions written by only one prescriber?
That would be the case if new legislation, the Stopping Medication Abuse and Protecting Seniors Act, becomes law. The Senate Finance Committee recently held a hearing on the bill, which has bipartisan support.
One of the cosponsors, Sen. Pat Toomey, R-PA, said the bill is aimed at reducing overprescribing and drug diversion, stating that the Government Accountability Office (GAO) “estimates that 170,000 Medicare enrollees have engaged in doctor shopping, where they go to multiple doctors who then typically unknowingly write duplicative prescriptions that are then filled at multiple pharmacies for the very same analgesic. It’s an easy way for people to find commercial-scale quantities of opioids which they can then sell on the black market.”
Toomey added that the law also would be beneficial for patients who are “innocently getting duplicative opioid prescriptions from multiple doctors and pharmacies because there is insufficient coordination of their care, but that can lead to very, very bad health outcomes, including death, for these innocent seniors.”
According to the bill’s provisions, patients would choose their healthcare provider and pharmacy, with exemptions for chronically ill patients such as those in hospice care. Patients would have the ability to change pharmacies if necessary.
Other sponsors include Sens. Sherrod Brown (D-OH), Rob Portman (R-OH), and Tim Kaine (D-VA).
Portman said, “It was mentioned that the Comprehensive Addiction and Recovery Act was reported out of the Judiciary Committee hearing by a unanimous vote last week, that doesn’t happen around here. And it did so because it’s bipartisan, we have worked on it for several years, we have brought in all of the experts to make sure it actually addresses the problem. But also because all of us see this epidemic growing in our states, and we see the human toll.”
He praised the bill because it would help end “pharmacy shopping and doctor shopping that leads to abuse.”
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 the Department of Health and Human Services 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 government entities, health 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.
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