In 1968, The New York Times published an article highlighting the resilience of a species. "A nuclear war, if it comes, will not be won by the Americans … the Russians … the Chinese. The winner of World War III will be the cockroach.”
For any of you who have lived in a city surrounded by heat, trash, and water, you are bound to chuckle at this thought.
Yes, the cockroach is a proven survivor, but the American is a fighter. We founded this country fighting for our freedom and we created generations of driven Americans who are fighting for exceptionalism.
Unfortunately, there is something that is taking away our fight, our drive, our passion, and it is opioids.
These prescription drugs are numbing our senses and ravaging our communities. Imagine if every little boy under the age of five in the Dayton City School District disappeared in a single academic year? That’s about 5,126 boys, and 5,232 people died in Ohio last year from overdoses. The craziest part about that number is that it rose 39 percent from 2016.
Now, many of these deaths were due to illicit drug use, but since 2006, over 7,000 Ohioans have died from overdosing on prescription opioids. These are people who received this medication through drug diversion, resale, or through a legal prescription from their doctor that had too high a dosage.
This problem is readily apparent in the Medicare Part D program. In 2016, over 500,000 Medicare beneficiaries were written prescriptions for opioids at nearly 2 ½ times the recommended maximum for long-term usage. Nearly 70,000 beneficiaries were written prescriptions at almost 5 times that recommended max. Whether through providers’ lack of training on appropriate dosages or – at worst, through negligence or fraudulent and abusive prescribing – there are hundreds of thousands of seniors who are being unnecessarily exposed to health risks and addiction.
The Centers for Medicare and Medicaid Services (CMS), which runs the Medicare program, does have an Opioid Misuse Strategy, which aims to lower opioid overprescribing, drug diversion, and fraud within the Part D program. While these are all laudable goals, CMS itself has handicapped its ability to measure its progress.
CMS currently requires all health insurers offering Part D or Medicare Advantage plans to institute a compliance program to detect fraud, waste, and abuse and take corrective action against providers engaging in misconduct. However, while it encourages them to report this fraud, waste, and abuse they find, it doesn’t actually require them to do so. This makes no sense when CMS has goals to eliminate these very things. How are we supposed to eliminate drug diversion if we don’t know the number of fraudulent providers who are engaging in it? How are we supposed to eliminate overprescribing if we don’t know what steps are being taken to end it?
Remember, when plan sponsors do share information with CMS and ask for help in their investigations, they often find the agency to be a black box. CMS is not required to share with them the results of its own investigations and corrective actions, as well as information on misconduct and fraud schemes reported by other plan sponsors. The lack of transparency and communication significantly undermines each’s ability to combat fraud and abuse within the Part D program, as well as to reduce overprescribing.
That’s why I introduced the Strengthening Partnerships to Prevent Opioid Abuse Act, which will make common-sense changes to encourage greater data sharing and coordination between CMS and insurers. This will help each of them to reduce overprescribing, fraud, and abuse within Medicare Part D. My bill requires Part D and Medicare Advantage plan sponsors to share information on the investigations and actions they take related to providers who prescribe dangerously high volumes of opioids. It also requires CMS to respond to plans regarding their referrals and the results of its investigations.
Also, by creating an online portal to facilitate this exchange of information, providers who are overprescribing or committing fraud can be easily located and appropriate action can be taken to resolve these problems. Once the fraudulent providers are removed and overprescribers are better educated on appropriate prescribing methods, fewer seniors will be at risk of overdose and addiction, allowing them to live fuller lives.
Congress is not going to deliver the answer to this crisis. The 50-plus bills we pushed this month may help, but if we can start limiting some bad actors who are overprescribing, we can make a small dent in the fight. That fight, that drive, that passion that Americans collectively share, is how we are going to protect our children and grandchildren from our mistakes and allow them to continue to strive for exceptionalism.