H.R. 3392, the “Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013"

On October 30, 2013, Reps. Gus Bilirakis (R-FL) and Ben Ray Lujan (D-NM) introduced H.R. 3392, the Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013.

The Department of Health and Human Services Inspector General (HHS OIG) has raised concerns about efforts by the Medicare Part D program to prevent and track fraud and abuse, including improper prescribing and prescription drug abuse.  H.R. 3392 would require prescription drug plans (PDPs and MA-PDs) to develop a safety program to prevent fraud and abuse in the dispensing of controlled substances under Medicare Part D.  Specifically, the bill would:

• Establish procedures to identify individuals using certain controlled substances and notify them that they have been identified.
• Lock beneficiaries into a “safe pharmacy network” at which they have their prescriptions filled and limit coverage based on beneficiaries’ mobility and proximity to a “safe pharmacy”—i.e., a pharmacy able to properly monitor usage of certain controlled substances and meet other drug safety criteria established by a PDP/MA-PD sponsor or the Secretary.
• Provide the Secretary with the names of beneficiaries identified and potentially disenrolled from a plan.  The Secretary must then share identified beneficiaries’ information with PDP sponsors for subsequent plan enrollments.
• Allow for the suspension of pharmacy payments pending investigation of credible allegations of fraud, as identified by:  (1) Medicare fraud hotline complaints; (2) claims analysis fraud detection; (3) audits, civil false claims cases, and law enforcement investigations that detect inappropriate dispensing; and (4) claims referred to Medicare Drug Integrity Contractors (MEDIC).
• Strengthen the role of MEDICs, by allowing them direct access to prescription and medical records from pharmacies, PDPs, and physicians.