AMCP Welcomes “21st Century Cures” Provisions Addressing Drug Abuse, Fraud in Medicare Part D

Alexandria, Va., Jan. 29, 2015 — The Academy of Managed Care Pharmacy (AMCP) applauds two crucial provisions in draft legislation issued this week by the House Energy and Commerce Committee that combat the abuse of controlled substances and payment fraud in the Medicare Part D prescription drug benefit program.

AMCP Chief Executive Officer Edith A. Rosato, RPh, IOM issued the following statement:

The Academy is pleased the Committee’s bill includes Sec. 4281, which calls for creating safe pharmacy networks in Part D to prevent the abuse and diversion of controlled substances, and Sec. 4282, which authorizes Part D plans to suspend payment of claims to pharmacies suspected of a credible allegation of fraud.

While we are still analyzing these provisions in detail, we are gratified to see they are part of the larger discussion on improving patient health and ensuring the integrity of our health care system. These are issues that AMCP has taken the lead on for years. In the coming weeks, we will be offering lawmakers on the Committee in-depth recommendations on how these proposals might be modified to have the biggest positive impact.

The nearly 400-page draft bill, which stems from the Committee’s bipartisan 21st Century Cures initiative last year, aims to accelerate discovery, development and delivery of new drugs and therapies. It also includes reforms of various health care programs such as Medicare Part D. The Committee said it hopes to present legislation to President Obama by the end of the year.

The Academy has developed detailed positions on both Part D topics. 

  • On controlled substances, AMCP’s position includes amending current law to allow Part D prescription drug plans and Medicare Advantage prescription drug plans to limit patients with a history of abuse to a single prescriber and/or pharmacy (or chain of pharmacies), similar to what already occurs in the private market and the Medicaid program.
  • On anti-fraud, AMCP’s position includes amending current law to allow health plans to withhold payments to pharmacies that are suspected of fraud in the program. This solution would allow plans to combat suspected fraud before payments are made, instead of attempting to recover the payments after the fact, which is often a difficult, if not impossible, task.

The Academy’s position paper on controlled substances can be found here. The position paper on Part D fraud can be found here.