summary
Introduced
07/30/2015
07/30/2015
In Committee
07/30/2015
07/30/2015
Crossed Over
Passed
Dead
01/03/2017
01/03/2017
Introduced Session
114th Congress
Bill Summary
Stopping Medication Abuse and Protecting Seniors Act of 2015 This bill amends title XVIII (Medicare) of the Social Security Act to: (1) authorize a Medicare prescription drug plan (PDP) sponsor to establish a drug management program under which the PDP sponsor may limit an at-risk beneficiary's access to coverage for frequently abused drugs to include only those drugs that are prescribed by selected prescribers and dispensed by selected pharmacies; and (2) require a PDP sponsor to have in place a utilization management tool to prevent drug abuse. With respect to a drug management program, a PDP sponsor must: (1) provide specified notice to a beneficiary who has been identified by the Centers for Medicare & Medicaid (CMS) as "at-risk" and consequently enrolled in the program; and (2) in selecting prescribers and dispensers, ensure that the beneficiary continues to have reasonable access to drugs. These determinations shall be subject to expedited reconsideration and appeal. A PDP sponsor must review and consider an at-risk beneficiary's preferences regarding prescriber and pharmacy selection. Certain individuals, including those receiving hospice care or residing in a long-term care facility, are exempted from enrollment in a drug management program. CMS must, for purposes of quality or performance assessments, review and consider complaints received from at-risk beneficiaries regarding lack of access due to their enrollment in a drug management program. In addition, CMS must establish rules and procedures requiring a PDP sponsor to provide specified program data.
AI Summary
This bill, the Stopping Medication Abuse and Protecting Seniors Act of 2015, aims to combat prescription drug abuse within Medicare by allowing Medicare prescription drug plan (PDP) sponsors to implement drug management programs for beneficiaries identified as "at-risk." Under these programs, PDP sponsors can limit an at-risk beneficiary's access to frequently abused drugs to only those prescribed by selected doctors and dispensed by selected pharmacies, provided the beneficiary is given proper notice and has reasonable access to necessary medications, with options for expedited appeals. The bill also mandates that PDP sponsors use tools to monitor drug use and prevent abuse, and it exempts certain individuals, such as those receiving hospice care or living in long-term care facilities, from these programs, while requiring the Centers for Medicare & Medicaid (CMS) to consider complaints about lack of access and collect program data.
Committee Categories
Budget and Finance
Sponsors (26)
Pat Toomey (R)*,
John Barrasso (R),
Roy Blunt (R),
John Boozman (R),
Sherrod Brown (D),
Richard Burr (R),
Shelley Moore Capito (R),
Bob Casey (D),
Bill Cassidy (R),
Daniel Coats (R),
Thad Cochran (R),
Susan Collins (R),
John Cornyn (R),
Tom Cotton (R),
Michael Enzi (R),
Dianne Feinstein (D),
Jeff Flake (R),
Chuck Grassley (R),
Orrin Hatch (R),
Dean Heller (R),
Tim Kaine (D),
John McCain (R),
Mitch McConnell (R),
Rob Portman (R),
Mike Rounds (R),
David Vitter (R),
Last Action
Read twice and referred to the Committee on Finance. (on 07/30/2015)
Official Document
bill text
bill summary
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bill summary
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bill summary
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