Today, Congressman Frank Pallone, Jr. (NJ-06) joined with community leaders at CVS Pharmacy in South Plainfield, New Jersey to announce his legislation, the Medicare Prescription Drug Integrity Act, to address new reports of inappropriate payments for prescriptions of controlled substances in Medicare's Part D program.
Pallone is the Ranking Member of the House Energy and Commerce Subcommittee on Health and wrote his bill on the heels of a Health and Human Services Office of Inspector General's report released last month, which found that Medicare paid for 30,000 prescriptions for controlled substances that were ordered by individuals who did not have the authority to prescribe prescription drugs prescribed by unauthorized individuals including massage therapists, athletic trainers, social workers and interpreters. The report also states that of these prescriptions, more than 7,000 were narcotics, such as oxycodone, which have the highest potential for abuse and can be diverted and resold for profit.
"Prescription drug abuse is an epidemic, and in New Jersey, it is on the rise," said Pallone. "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. We cannot allow Medicare's prescription drug program to be compromised at taxpayer expense. My bill, the Medicare Prescription Drug Integrity Act of 2013, will strengthen the Medicare law to help address potential factors contributing to prescription drug abuse."
Pallone was joined by leaders in the community working to combat prescription drug abuse including Assemblyman Patrick Diegnan, Shauna Moses, Associate Executive Director of New Jersey Association of Mental Health and Addictions Agencies, Inc.; Angelo M. Valente, Executive Director of Partnership for a Drug-Free New Jersey; and Saira A Jan, M.S., Pharm.D., Director of Clinical Pharmacy Management at Horizon Blue Cross Blue Shield of New Jersey.
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.
The bill 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. In addition, the bill will provide the Secretary of Health and Human Services (HHS) new tools to prevent the payment of claims by fraudulent prescribers or pharmacies.
Prescription drug abuse has emerged as a serious and growing problem. According to the Centers for Disease Control and Prevention, more than 20,000 deaths occur each year due to the misuse and abuse of prescription drugs and one in 20 Americans say they have used prescription painkillers for non-medical reasons in the last year.