February 26, 2015

Legislation passed today by the House Ways and Means Committee, includes a pharmacy provision to help prevent inappropriate prescriptions in Medicare Part D from crossing the pharmacy counter. The Protecting the Integrity of Medicare Act (PIMA) of 2014, introduced by Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA), recognizes the need to address the prescription drug abuse epidemic and implement the right policies, said the Pharmaceutical Care Management Association (PCMA).

“The key to stopping ‘drugstore shopping’ is preventing improper prescriptions from being filled in the first place,” said PCMA President and CEO Mark Merritt. “This approach ensures high-quality standards at pharmacies that dispense opioids and other addictive medicines to at-risk patients.”

The pharmacy program in Medicare Part D for controlled substances allows Part D plans and beneficiaries to choose a specific pharmacy from which that beneficiary would get controlled substances. The policy maintains beneficiary access to needed medications, but prevents “drugstore shopping.”

A recent report by the Health and Human Services Office of Inspector General, “Part D Beneficiaries with Questionable Utilization Patterns for HIV Drugs,” calls for a similar pharmacy provision program in Part D. The Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Government Accountability Office and the Office of National Drug Control Policy also have called for such a program in Medicare. Currently, 46 state Medicaid agencies operate these programs and 49 states have enacted prescription drug monitoring legislation.