Washington, D.C. – Today, Reps. Jim Renacci (R-OH), Terri Sewell (D-AL), Brett Guthrie (R-KY), and Scott Peters (D-CA) introduced the Strengthening Partnerships to Prevent Opioid Abuse Act. This legislation would improve the coordination between the Centers for Medicare and Medicaid Services (CMS) and plan sponsors of Medicare Advantage and Part D prescription drug plans to combat fraud, waste, and abuse and the overprescribing of opioids within the Medicare Part D Program.
“Over half a million Medicare beneficiaries were written prescriptions for excessive amounts of opioids in 2016, and 90,000 beneficiaries are at serious risk of opioid misuse or overdose,” said Renacci. “The Strengthening Partnerships to Prevent Opioid Abuse Act will facilitate greater and more meaningful collaboration between CMS and industry stakeholders to identify instances in which a provider is overprescribing opioids or is engaging in fraud and abuse and endangering the well-being of America’s seniors.”
“Opioid addiction is a national health emergency that deserves an immediate national response,” said Sewell. “In Alabama, which is first in the nation for the number of painkiller prescriptions per capita, this crisis has left tens of thousands of men and women in a deadly cycle of addiction. The Strengthening Partnerships to Prevent Opioid Abuse Act combats abuse and fraud within the Medicare Part D Program, cracking down on the dangerous overprescription of opioids. Lives are at stake, and this legislation takes a commonsense step forward in our fight to end the opioid epidemic.”
“As Congress takes a comprehensive approach to combatting our nation’s opioid crisis, we must address abuse in the Medicare Part D and Medicare Advantage plans that allows providers to slip through the cracks in the existing system and over-prescribe opioids to already at-risk patients,” said Guthrie, vice chair of the House Energy and Commerce Committee’s Health Subcommittee. “I was proud to join with Representatives Renacci, Sewell, and Peters in introducing this bill to give CMS the tools it needs to address fraud and waste in the Medicare Part D and Medicare Advantage plans and to help protect Kentuckians from excess opioid use.”
“Opioid abuse has taken and hurt too many lives in communities across the country,” said Peters. “In San Diego, opioids are the leading cause of unintended death and we must do more to address this national public health emergency. The experts have told Congress what to do, and, while we have taken steps to address aspects of the crisis, our work is far from over. This bill takes a critical step in the right direction, by increasing oversight on opioid prescribing under Medicare Part D. San Diegans are counting on Congress to get it right. I will continue to work with my colleagues—and all the major players in our nation’s health care system—to resolve these concerns.”
Under current law and regulations, CMS has tasked plan sponsors with identifying and taking corrective action against providers engaging in fraud and abuse within the Part D program. While plan sponsors are encouraged to refer cases of fraud and abuse to CMS, they are not required. This inhibits CMS’s ability to track its progress in reducing inappropriate prescribing, drug diversion, and opioid use disorders – all of which are goals of its Opioid Misuse Strategy.
Building on recommendations from the Government Accountability Office and the Office of Inspector General at the Department of Health and Human Services, the Strengthening Partnerships to Prevent Opioid Abuse Act would create an online portal through which plan sponsors would be required to report opioid overprescribing and would refer substantiated case of fraud and abuse to CMS. Using this portal, CMS would also be required to inform plans of its corrective actions regarding providers who have engaged in fraud and abuse, facilitate the sharing of referral information between plans, and inform plans of the resolution of their referrals.