CLEVELAND, OH – In Cleveland today, U.S. Sen. Sherrod Brown (D-OH) unveiled a new effort to address prescription drug abuse by cracking down on “doctor-shopping.” During a press conference at the Benjamin Rose Institute on Aging, Brown outlined how the creation of a Medicare lock-in program would help the estimated 170,000 Medicare beneficiaries who are battling opioid addiction receive the help they need while saving taxpayer dollars. Brown joined Rich Browdie, President & CEO, Benjamin Rose Institute on Aging, and Dennis Michelson, of Painsville, who became addicted to prescription opiates after seeking medical help for prescription migraines.

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

Brown announced new legislation he is cosponsoring that would create a patient review and restriction, or “lock-in” program – similar to drug diversion prevention plans already in Medicaid and commercial plans – that would limit beneficiaries with a history of drug abuse to seeing one prescriber and one pharmacy. This drug abuse prevention plan will also encourage insurers, Part D plan sponsors, and health care professionals to assist beneficiaries battling addiction in seeking substance abuse treatment.

“This bill, modeled after the current Medicaid lock-in process, will help to prevent prescription drug abuse, diversion and overdosing. Helping members identify the best options for their treatment can create a safety net while offering quality care,” said Pamela Morris, President & CEO CareSource.

Specifically, 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.