July 24, 2013
The Pharmaceutical Care Management Association (PCMA) released a set of policy solutions—The Safe Rx Initiative—aimed at reducing prescription drug abuse and fraud in Medicare and the commercial sector by enhancing the current system to make it more difficult for drug-seekers consumers to obtain fraudulent prescriptions at the pharmacy counter.
Read PCMA’s letter to Congress outlining policies that would deliver real results in both the short and long term. The policy proposals target the overall marketplace and are also directed at improving Medicare.
1. Create ‘Safe Pharmacies’ in Part D for Controlled Prescription Drugs. Allow Part D plans to create a select number of “safe pharmacies” that can dispense controlled substances to beneficiaries at high-risk for abuse. This maintains beneficiary access to needed medications, but prevents “drugstore shopping.”
2. Require Drugstores and Pharmacists to Register With State Prescription Drug Monitoring Programs (PDMPs). PDMPs can alert pharmacists when someone is “drugstore shopping” to acquire controlled substances. Unfortunately, most drugstores choose not to participate in PDMP programs. In Nevada, only 14 percent of pharmacists are even registered to use their PDMP system. Unless pharmacists are registered, they cannot take the next step and actively participate in these programs.
3. Allow Payers to Coordinate with State Drug Monitoring Databases. The overwhelming amount of prescription drug abuse occurs when prescriptions are paid for in cash. These purchases are never seen by public or private insurers. Payers need access to prescription cash sales data in order to detect drugstore shopping. Access to state drug monitoring programs provides these data and helps payers spot patterns of abuse.
4. Give Part D Plans the Same Fraud Prevention Tools as Plans in Medicare Parts A & B. In Medicare Parts A and B (and Medicaid) plans have stronger authority to detect fraud and suspend payments before claims are paid. This is not the case in Medicare Part D. Congress should clarify that Part D plans – like those in Medicare Parts A and B – can suspend reimbursements at any time based on a “credible allegation” of prescription drug fraud, waste, or abuse, and can also use the same 30-day reimbursement schedule used to pay doctors and hospitals that participate in Medicare.
5. Create Uniform, Federal ‘Track and Trace’ Standards. Congress should authorize a national, uniform system that tracks prescription drugs throughout the supply chain. A patchwork of state laws is unworkable if a drug is tracked by wholesalers and the rest of the supply chain across multiple states.