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Pallone to Introduce Bill to Prevent Medicare Prescription Drug Abuse and Fraud

July 8, 2013
Press Release

Washington, DC – Today, Congressman Frank Pallone, Jr. (NJ-06), Ranking Member of the House Energy and Commerce Subcommittee on Health announced that he is set to introduce legislation to address new reports of inappropriate payments for prescriptions of controlled substances in Medicare’s Part D program. 

“Prescription drug abuse is an epidemic,” said Pallone.  “Millions of Americans benefit from Medicare’s drug coverage program each year, which is why it’s imperative that checks are in place to prevent fraud and abuse as well as to protect patients.  We cannot allow Medicare’s prescription drug program to be compromised at taxpayer expense.  My bill, the Part D Prescription Drug Integrity Act of 2013, will strengthen the Medicare law to help address potential factors contributing to prescription drug abuse.”

Under Medicare Part D, the Centers for Medicare and Medicaid Services (CMS) contracts with private insurance companies, known as plan sponsors, to provide prescription drug coverage to beneficiaries who choose to enroll.  Pallone’s bill would require plan sponsors to verify that a prescription for a drug on the Controlled Substances list was made by an authorized physician before paying for the drug. Under the current law, such a requirement does not exist.  

The bill would also require plan sponsors to have drug utilization programs in place that would restrict access if there was credible evidence of beneficiaries abusing or diverting drugs.  Most state Medicaid programs have utilization programs, but similar guidelines are not in place for most Part D beneficiaries.  In addition, the bill will provide the Secretary of Health and Human Services (HHS) new tools to prevent the payment of claims by fraudulent prescribers or pharmacies.  

Pallone wrote his bill on the heels of a HHS Office of Inspector General’s report released last month, which found that Medicare is paying for prescription drugs prescribed by unauthorized individuals including massage therapists, athletic trainers, social workers and interpreters.  Given that tens of thousands of these drugs were controlled substances, the study’s findings raise questions about patient safety because of the potential for prescription drug abuse.

Prescription drug abuse has emerged as a serious and growing problem.  According to the Centers for Disease Control and Prevention, more than 20,000 deaths occur each year due to the misuse and abuse of prescription drugs and one in 20 Americans say they have used prescription painkillers for non-medical reasons in the last year.