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Preventing Prescription Drug Abuse

The ranking member of the House Energy and Commerce Subcommittee on Health says he’ll introduce legislation to address new reports of inappropriate payments for prescriptions of controlled substances in Medicare’s Part D program.

Frank Pallone
Rep. Frank Pallone (CSPAN)

“Prescription drug abuse is an epidemic,” says Congressman Frank Pallone (NJ-06). “Millions of Americans benefit from Medicare’s drug coverage program each year, which is why it’s imperative that checks are in place to prevent fraud and abuse as well as to protect patients.”

Under Medicare Part D, the Centers for Medicare and Medicaid Services (CMS) contracts with private insurance companies, known as plan sponsors, to provide prescription drug coverage to beneficiaries who choose to enroll. Pallone’s bill would require plan sponsors to verify that a prescription for a drug on the Controlled Substances list was made by an authorized physician before paying for the drug. Under the current law, such a requirement does not exist.

“We cannot allow Medicare’s prescription drug program to be compromised at taxpayer expense,” says Pallone. “My bill, the Part D Prescription Drug Integrity Act of 2013, will strengthen the Medicare law to help address potential factors contributing to prescription drug abuse.”

The measure would also require plan sponsors to have drug utilization programs in place that would restrict access if there was credible evidence of beneficiaries abusing or diverting drugs. Most state Medicaid programs have utilization programs, but similar guidelines are not in place for most Part D beneficiaries.

The bill will also provide the Secretary of Health and Human Services (HHS) new tools to prevent the payment of claims by fraudulent prescribers or pharmacies.

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