August 6, 2014
A new report by the Health and Human Services Office of Inspector General (HHS-OIG), “Part D Beneficiaries With Questionable Utilization Patterns for HIV Drugs,” calling for a pharmacy “lock in” program in Medicare Part D would help decrease prescription drug abuse, the Pharmaceutical Care Management Association (PCMA) said today.
“This report confirms the value of establishing safe pharmacy networks in Part D to improve quality and prevent fraud and abuse,” said PCMA President and CEO Mark Merritt. “The best place to address this is the pharmacy counter, where the drugs change hands from pharmacists to patients.”
The HHS-OIG report states:
“We found that a number of beneficiaries received similar drugs from extremely high numbers of pharmacies or prescribers. CMS should seek legislative authority, if necessary, to restrict certain beneficiaries to a limited number of pharmacies or to a limited number of prescribers, a practice commonly referred to as ‘lock-in’ … Restricting certain beneficiaries to a limited number of pharmacies or prescribers could reduce program costs and inappropriate utilization. It could also improve coordination of services and quality of care for these beneficiaries.”
Representatives Gus Bilirakis (R-Fla) and Ben Ray Luján (D-NM) sponsor legislation, H.R. 3392, “The Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013,” that is an important step in the fight against prescription drug abuse and fraud. The legislation gives drug plans the same authority to prevent fraud and abuse in Part D as they currently have in Medicare Parts A & B. The bill also directs Part D drug plans to create safe pharmacies to dispense controlled substances to those beneficiaries at high-risk for abuse.
Currently, 46 state Medicaid agencies operate “Lock In” programs, and 49 states have enacted prescription drug monitoring legislation.