Brown and Toomey’s Bipartisan Bill to Curb Addiction within Medicare Program Passes as Amendment

Brown Calls for Comprehensive Approach to Opioid Crisis, Says Serious Action Requires Serious Investment

WASHINGTON, D.C. – U.S. Sens. Sherrod Brown (D-OH) and Pat Toomey’s (R-PA) bipartisan bill to prevent wrongful access to opioids and improve patient care for Medicare beneficiaries passed today as an amendment to the Comprehensive Addiction and Recovery Act being considered in the Senate this week.

The Stopping Medication Abuse and Protecting Seniors Act would implement an effective drug abuse prevention plan already operating in Medicaid and commercial plans in Medicare. The plan identifies beneficiaries with histories of drug abuse in Medicare Part D and Medicare Advantage and locks them into one prescriber and one pharmacy to help manage potential addiction. U.S. Sens. Rob Portman (R-OH) and Tim Kaine (D-VA) are also cosponsors.

“Too often when we think of the opioid epidemic, we forget that there are seniors struggling with addiction who need our help,” said Brown. “With the right tools, our health care providers can better identify seniors who need help and reduce the risk of addiction in the first place. Our bill will help seniors get better care and save taxpayers millions of dollars by cutting down on overprescribing of addictive medications that don’t actually make patients any healthier.”  

While applauding passage of his amendment, Brown also continued his call for a comprehensive approach to solving the opioid crisis from prevention to recovery. Shortly after passing the Brown-Toomey bill, the Senate rejected an amendment offered by U.S. Sen. Jeanne Shaheen (D-NH) that would have provided $600 million directly to the public health workers and law enforcement officials working on the front lines of the opioid epidemic. 

“I’m pleased that we have bipartisan support for this commonsense measure. But this amendment, and this bill, are only a first step, and I am disappointed the Senate chose not to put people above politics and make a meaningful investment in this fight,” Brown said. “If we are serious about fighting the opioid epidemic, we have to be willing to make the serious investment it will take to deliver results. We’re only going to make real headway when we combat this crisis at every level – and provide the funding necessary to back up those efforts.”

In addition to creating a “lock-in” mechanism to curb wrongful access to opioids, the bill would also encourage insurers, Part D plan sponsors, and physicians to assist beneficiaries battling addiction in seeking substance abuse treatment. The bipartisan legislation will save taxpayers nearly $100 million over 10 years by eliminating fraudulent and medically unnecessary prescription payments from Medicare.

The Government Accountability Office (GAO) 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 opioid 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 the 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” opioids.
  • 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 opioids 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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