summary
Introduced
03/23/2016
03/23/2016
In Committee
03/29/2016
03/29/2016
Crossed Over
Passed
Dead
01/03/2017
01/03/2017
Introduced Session
114th Congress
Bill Summary
Medicare Prescription Drug Abuse Prevention Act of 2016 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 Medicare Prescription Drug Abuse Prevention Act of 2016, aims to combat prescription drug abuse within the Medicare program by allowing Medicare Prescription Drug Plan (PDP) sponsors to implement drug management programs for beneficiaries identified as "at-risk" for drug abuse. 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, ensuring beneficiaries are notified and have a say in these selections, with options for expedited appeals if they disagree. The bill also mandates that PDP sponsors use utilization management tools to prevent drug abuse and requires the Centers for Medicare & Medicaid (CMS) to consider complaints from beneficiaries about access issues related to these programs and to collect specific program data. Certain individuals, such as those receiving hospice care or residing in long-term care facilities, are exempt from these drug management programs.
Committee Categories
Business and Industry, Health and Social Services
Sponsors (4)
Last Action
Referred to the Subcommittee on Health. (on 03/29/2016)
Official Document
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