Bill > HR2298

This bill, the Medicare Patient Safety and Drug Abuse Prevention Act, aims to combat prescription drug abuse and diversion within Medicare's prescription drug benefit program (Part D) and Medicare Advantage Prescription Drug (MAPD) plans. It allows prescription drug plan (PDP) sponsors to establish "drug management programs" for beneficiaries identified as "at-risk" for prescription drug abuse. These programs can limit an at-risk beneficiary's access to frequently abused drugs, requiring them to obtain these medications from a specific prescriber and pharmacy selected by the PDP sponsor, after providing the beneficiary with detailed notices and opportunities to appeal. The bill also mandates that PDP sponsors and Medicare Advantage organizations implement "utilization management tools" to prevent drug abuse and diversion, and requires them to report identified problematic prescribers and pharmacies to Medicare drug integrity contractors (MEDICs). MEDICs, which are entities contracted by the Department of Health and Human Services (HHS) to combat fraud, will be authorized to directly receive prescription and medical records from pharmacies, PDPs, and physicians to help identify at-risk beneficiaries. Furthermore, the Inspector General of HHS will study the effectiveness of MEDICs in fighting Medicare fraud. Finally, the bill expresses a sense of Congress that Medicare Advantage organizations and PDP sponsors should consider using electronic prescribing and other health information technology to help prevent fraud.