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Toomey-Authored SUPPORT Act Provisions Included in CMS’s New Proposed Regulations

February 10, 2020
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Washington, D.C. - U.S. Senator Pat Toomey (R-Pa.) issued the following statement on the proposed changes to Medicare Advantage and Part D recently announced by the Centers for Medicare and Medicaid Services (CMS):

"Pennsylvania has been hit hard by the opioid epidemic and while significant steps have been taken to address it, more work remains," said Senator Toomey. "CMS is proposing to implement three provisions I authored as part of the 2018 SUPPORT for Patients and Communities Act that would help ensure Medicare is a better steward of opioid prescriptions and takes commonsense steps to prevent abuse and misuse. I look forward to working with CMS to enact these provisions and improve Medicare for seniors and people with disabilities."

Background
In 2018, according to the Centers for Disease Control and Prevention (CDC), the number of drug overdose deaths in the United States involving prescription opioids, such as codeine and oxycodone, declined for the first time since 2012[1]. In Pennsylvania, total drug overdose deaths decreased by 18 percent from 2017 and prescription opioids were found in 18 percent of all overdoses, a small reduction below the prior year's figure.[2] Despite this progress, in 2018 Pennsylvanians were dying from drug overdoses at the fourth highest rate in the nation.[3]

The three provisions authored by Senator Toomey are:

  1. Drug Management Program: CMS is proposing the requirement of mandatory implementation of drug management program (DMP) by Part D sponsors, for plan years beginning on or after January 1, 2022. Prior to passage of the SUPPORT Patients and Communities Act this provision was optional for plans.
  2. Previous Overdose Support and Reporting: CMS has proposed to include Part D beneficiaries with a history of opioid-related overdose as a Potential At Risk Beneficiary, qualifying these individuals for Drug Management Programs, and CMS has proposed to notify the plan sponsor of such identifications. Prior to passage of the SUPPORT Patients and Communities Act, no notification or case management was required solely based on previous non-fatal overdose occurrence, despite studies linking previous non-fatal overdoses to subsequent fatal overdoses.
  3. Increased waste fraud and abuse protections: CMS has proposed improvements to data sharing between plans and CMS that prevents fraud, waste, or abuse and increases information sharing on plan actions related to inappropriate opioid prescribing. Prior to passage of the SUPPORT Patients and Communities Act, this level of coordination was not required.

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[1] "Data Brief 356. Drug Overdose Deaths in the United States, 1999-2018," Centers for Disease Control and Prevention, https://www.cdc.gov/nchs/data/databriefs/db356_tables-508.pdf#3
[2] "Drug-Related Overdose Deaths in Pennsylvania, 2018," Drug Enforcement Administration, https://www.dea.gov/sites/default/files/2019-10/PRB%20FINAL%20--%20BUL-132-19%20Drug-Related%20Overdose%20Deaths%20in%20Pennsylvania%2C%202018.pdf
[3] Holly Hedegaard, Arialdi M. Miniño, Margaret Warner, "Drug Overdose Deaths in the United States, 1999-2018," Centers for Disease Control and Prevention, https://www.cdc.gov/nchs/data/databriefs/db356-h.pdf