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Toomey Introduces Legislation To Save Lives And Reduce Health Care Costs

The Stopping Medication Abuse and Protecting Seniors Act Would Help to Cut Down on Drug Abuse, End Dangerous Practice of Doctor Shopping

August 3, 2015

WASHINGTON, D.C. - US. Senator Pat Toomey (R-Pa.) is working to help end the plague of prescription drug abuse. Toomey and Sens. Sherrod Brown (D-Ohio), Rob Portman (R-Ohio), and Tim Kaine (D-VA) 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. Toomey's bipartisan legislation will save taxpayers between $79 and $115 million over 10 years by eliminating fraudulent and medically unnecessary prescription payments from Medicare.

"We are taking great strides in the fight against opioid abuse by eliminating the practice of doctor shopping and helping those battling addiction into treatment," Sen. Toomey said. "We're demonstrating that by working together, we can all be part of the solution - a solution that saves lives, protects taxpayers, and helps rebuild families."

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 Sen. Toomey's legislation.

"Americans all across the country have been affected by the growing public health crisis caused by addiction to opioids and other prescription drugs," Sen. 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."

"Our bill will protect those at risk of prescription drug abuse, while also maintaining patients' rights," Sen. 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."

"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 Sen. 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."

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.