AMCP Members, Staff Urge Lawmakers to Take Action on Opioid Abuse and Part D Fraud

Alexandria, Va., September 29, 2015 — A group of members and staff from the Academy of Managed Care Pharmacy (AMCP) will meet this week with more than 120 congressional offices to advocate for legislation in two critical areas: managing patients at-risk for abuse of controlled substances and boosting efforts to fight fraud in the Medicare Part D prescription drug program.

The issues are front and center at AMCP’s annual Legislative Days event, Sept. 29 and 30, with members of Congress, committee staff and legislative aides from both the House and Senate. More than 20 members from the Academy’s Board of Directors, Public Policy Committee and Legislative and Regulatory Action Committee are participating in the meetings.

“The Academy’s goal is to put opioid abuse and Medicare Part D fraud on Congress’s radar,” says AMCP CEO Edith A. Rosato, RPh, IOM. “Evidence is mounting that legislation in these areas will curb the epidemic of opioid and other prescription drug abuse and save taxpayer dollars – we are confident that our message will get through this week and our proposals will gain congressional support.”

One of the primary messages is AMCP’s support for an amendment to the Medicare Part D law that would allow prescription drug plans and Medicare Advantage prescription drug plans to limit patients with a history of abuse to a single prescriber and/or pharmacy, similar to what currently is available in the private insurance market and Medicaid. Provisions allowing these limitations, known as prescription drug management programs (DMPs), are contained in the 21st Century Cures Act (H.R. 6) and Stopping Medication Abuse and Protecting Seniors Act of 2015 (S. 1913).

“DMPs help to mitigate the issues associated with doctor or pharmacy shopping, and may reduce the number of inappropriate controlled substance prescriptions,” says Mary Jo Carden, AMCP Vice President of Government & Pharmacy Affairs. “Forty-six states have successfully implemented DMPs through state Medicaid programs with positive results.”

On related note, AMCP is supporting amendments in the reauthorization of the National All Schedules Prescription Electronic Reporting Reauthorization Act (H.R. 1725 and S. 480) that would allow managed care organizations to access prescription DMP data in real time. Currently, access to prescription DMP data is generally available only to prescribers, pharmacists, providers and law enforcement personnel. It is not available to managed care organizations, Medicare Part D plans, Medicare Advantage plans and pharmacy benefit management companies.

Allowing access to the prescription DMP database by these entities will help identify instances of inappropriate utilization or abuse, whereby these entities can implement systems to ensure appropriateness of the prescriptions prior to dispensing, Carden says.

AMCP also is advocating for legislation that would help fight fraud and abuse in Medicare Part D by extending authority to the Department of Health and Human Services (HHS) Secretary to authorize the suspension of Part D claims based on a credible allegation of fraud. Currently the Secretary has that authority under Medicare Parts A and B, but not Part D. State Medicaid programs also are authorized to suspend such claims. AMCP seeks a sponsor for legislation to extend that authority to Medicare Part D.

For more information on these and other legislative priorities, visit