AMCP Urges Senate Passage of Opioid Addiction Fighting Bill Containing Medicare Abuse and Diversion Provision


The Academy of Managed Care Pharmacy urges the full Senate to pass the Comprehensive Addiction and Recovery Act of 2016" with a provision that tackles the issue of opioid abuse and diversion among Medicare Part D beneficiaries.


Alexandria, Va. - The Academy of Managed Care Pharmacy (AMCP) urges the full Senate to pass the “Comprehensive Addiction and Recovery Act of 2016” (S. 524) with a provision that tackles the issue of opioid abuse and diversion among Medicare Part D beneficiaries.

The full Senate is posed to approve S. 524 containing an amendment that would improve care coordination for opioid-addicted seniors and stop diversion by preventing Medicare beneficiaries from visiting multiple doctors and pharmacies to obtain illicit prescriptions. The amendment, sponsored by Sen. Pat Toomey (R-PA) and cosponsored by Sens. Sherrod Brown (D-OH) and Robert Casey (D-PA), was approved last week by a voice vote.

AMCP has actively supported the anti-diversion legislation through its lobbying efforts.

“S. 524 as amended will allow the Medicare Part D program to avail itself of well-established techniques used by private insurers to limit the abuse or diversion of opiates or other controlled substances among patients with a history or suspicion of inappropriate utilization,” said AMCP CEO Susan A. Cantrell, RPh, CAE. “The use of drug management plans can improve continuity of care among at-risk beneficiaries, while also ensuring beneficiaries with legitimate medical needs have continued access to effective pain control.”

The amendment would authorize Medicare Part D Prescription Drug Plans and Medicare Advantage drug plans to identify individuals at risk for controlled substance abuse and enroll them in drug management plans (DMPs), which restrict participants to a single prescriber and/or pharmacy (or chain of pharmacies). Once identified, beneficiaries could appeal and/or submit their preference for a specific DMP prescriber and pharmacy for their opioid prescriptions.

“AMCP believes that a holistic and comprehensive approach is needed to truly address this epidemic,” Cantrell added. “The amendment to extend these protections to our often most vulnerable population — our seniors – will greatly improve their care coordination.”

Deaths connected to prescription drug misuse now exceed those from heroin and cocaine combined. Moreover, the economic costs of prescription drug abuse are substantial. The nonmedical use of controlled substances results totals $72 billion in unnecessary costs annually, including lost productivity, costs to criminal justice system, and health care expenditures.

One effort currently underway by AMCP to help address the issue is forming an Addiction Treatment Advisory Group (ATAG), which will evaluate current gaps and barriers to addiction treatment services and develop recommendations to improve patient care. The ATAG will draw on expertise of national leaders from a wide range of organizations, including behavioral health organizations, outpatient treatment centers, nonprofit advocacy groups, health plans, pharmacy benefit management companies, specialty pharmacies, employers, hospitals and manufacturers.

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