Today, U.S. Senator Tim Kaine (D-VA) joined U.S. Senators Sherrod Brown (D-OH), Rob Portman (R-Ohio), and Pat Toomey (R-PA) to introduce the bipartisan Stopping Medication Abuse and Protecting Seniors Act to prevent inappropriate access to opioids and improve patient care for at-risk beneficiaries.
The legislation would prohibit Medicare Part D and Medicare Advantage patients suffering from drug addiction from filling multiple narcotic prescriptions written by different physicians, known as doctor shopping. The bill would also encourage insurers, Part D plan sponsors, and physicians to assist beneficiariesbattling addiction in seeking substance abuse treatment.The bipartisan legislation would save Medicare between $79 and $115 million over 10 years by eliminating fraudulent and medically unnecessary prescriptions. Similar provisions already exist in Medicaid and commercial plans.
“As we combat the opioid abuse epidemic that is harming communities in Virginia and across the country, it’s critical that we prevent patients with prescription drug addictions from filling multiple narcotics prescriptions at multiple pharmacies,” said Kaine. “I’m proud to co-sponsor this bill that will help prevent drug abuse and encourage substance abuse treatment among Medicare Part D beneficiaries suffering from drug addictions.”
This legislation is the most recent in a series of stepsKaine has taken to combat opioid abuse at the federal level. Kaine recently introduced bipartisan legislation to protect first responders, health professionals and family members who are educated in administering an opioid overdose prevention drug in an emergency situation of overdose, as well as a bill that would hold the U.S. Food and Drug Administration (FDA) accountable for the approval of new opioid drugs, ensuring experts’ voices are heard as new and potentially dangerous opioid medications are considered for approval. Kaine also supported an amendment that was included in the Fiscal Year 2015 National Defense Authorization Act (NDAA) that addressed concerns about overmedication among servicemembers by requiring the Secretary Of Defense to carry out a program of comprehensive medication management in military treatment facilities.
As the rate of pain medication abuse and overdose continues to rise, the Government Accountability Office (GAO) estimates 170,000 beneficiaries of Medicare may be battling addiction to pain medication. To combat opiate abuse, improve the continuity of care, and ensure 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 this bipartisan 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.
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