Opioid abuse: Legislation targets doctor shopping
The scourge of prescription drug abuse has seemingly permeated all aspects of our society here in the mountains, and the deadly epidemic shows no signs of abating. That’s why the battle must continue on the local, state and federal level.
One well-known contributing factor to this deadly affliction is a process commonly known as “doctor shopping.” As its name implies, doctor shopping is the process of drug addicts going from one doctor to the another in search of prescriptions to help support their habit. In other instances, the multiple prescriptions that are illegally obtained are then sold to other users and addicts.
That’s why we welcome legislation recently introduced in Washington that seeks to prevent inappropriate access to opioids. The bipartisan Stopping Medication Abuse and Protecting Seniors Act would prohibit Medicare Part D and Medicare Advantage patients suffering from drug addiction from filling multiple narcotic prescriptions written by different physicians, or doctor shopping. The legislation was introduced last week by U.S. Sen. Tim Kaine, D-Va., U.S. Sen. Sherrod Brown, D-Ohio, U.S. Sen. Rob Portman, R-Ohio, and U.S. Sen. Pat Toomey, R-Pa.
The bill would also encourage insurers, Part D plan sponsors, and physicians to assist beneficiaries battling addiction in seeking substance abuse treatment, according to Kaine. The lawmakers estimate the legislation would save Medicare between $79 million and $115 million over 10 years by eliminating fraudulent and medically unnecessary prescriptions. Similar provisions already exist in Medicaid and commercial plans.
“As we combat the opioid abuse epidemic that is harming communities in Virginia and across the country, it’s critical that we prevent patients with prescription drug addictions from filling multiple narcotics prescriptions at multiple pharmacies,” Kaine said. “I’m proud to co-sponsor this bill that will help prevent drug abuse and encourage substance abuse treatment among Medicare Part D beneficiaries suffering from drug addictions.”
As the rate of pain medication abuse and cases of overdoses continues to rise, the Government Accountability Office (GAO) estimates 170,000 beneficiaries of Medicare may be battling addiction to pain medication. The Stopping Medication Abuse and Protecting Seniors Act would:
• Honor beneficiary preferences for preferred single pharmacy and preferred single provider unless it is determined that using those providers will contribute to continued drug abuse.
• Notify an at-risk beneficiary of their new status, and conduct a clinical review to ensure seniors who need high amounts of pain pills are not inappropriately included in the program.
• Direct HHS to establish clinical criteria for determining who is an at-risk beneficiary based on use of “frequently abused” opiates.
• Exempt beneficiaries receiving hospice care and those receiving care at a nursing home via a long-term care pharmacy.
• Allow for data sharing between CMS, plans, and contractors to address waste, fraud, and abuse.
• Direct the GAO to study concerns of prescription drug abuse beyond opiates within Medicare.
The legislation is another important tool in the ongoing battle against prescription drug abuse. It merits prompt approval and passage by Congress.
