II 

115TH CONGRESS 

2D SESSION S. 2920 

To amend title XVIII of the Social Security Act to impose certain requirements under the Medicare program with respect to outlier prescribers 

of opioids. 

IN THE SENATE OF THE UNITED STATES 

MAY 22, 2018 

Mrs. MCCASKILL (for herself and Mr. TOOMEY) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to impose 

certain requirements under the Medicare program with 

respect to outlier prescribers of opioids. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Commit to Opioid 

5 Medical Prescriber Accountability and Safety for Seniors 

6 Act of 2018’’. 


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1 SEC. 2. MEDICARE REQUIREMENTS WITH RESPECT TO 

2 OUTLIER PRESCRIBERS OF OPIOIDS. 

3 Section 1860D–4(c)(4) of the Social Security Act (42 

4 U.S.C. 1395w–104(c)(4)) is amended by adding at the end 

5 the following new subparagraph: 

6 ‘‘(D) NOTIFICATION AND ADDITIONAL RE7 QUIREMENTS WITH RESPECT TO OUTLIER PRE8 SCRIBERS OF OPIOIDS.— 

9 ‘‘(i) NOTIFICATION.—Not later than 

10 January 1, 2021, the Secretary shall, in 

11 the case of a prescriber identified by the 

12 Secretary under clause (ii) to be an outlier 

13 prescriber of opioids, provide, subject to 

14 clause (iv), an annual notification to such 

15 prescriber (during the period in which such 

16 provider maintains such identification) 

17 that such prescriber has been so identified 

18 and including such resources on proper 

19 prescribing methods and such other infor20 mation as specified in accordance with 

21 clause (iii). 

22 ‘‘(ii) IDENTIFICATION OF OUTLIER

23 PRESCRIBERS OF OPIOIDS.— 

24 ‘‘(I) IN GENERAL.—The Sec25 retary shall, subject to subclause (III), 

26 using the valid prescriber National 


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1 Provider Identifiers included pursuant 

2 to subparagraph (A) on claims for 

3 covered part D drugs for part D eligi4 ble individuals enrolled in prescription 

5 drug plans under this part and MA– 

6 PD plans under part C and based on 

7 the thresholds established under sub8 clause (II), identify prescribers that 

9 are outlier opioids prescribers for a 

10 period of time specified by the Sec11 retary. 

12 ‘‘(II) ESTABLISHMENT OF

13 THRESHOLDS.—For purposes of sub14 clause (I) and subject to subclause 

15 (III), the Secretary shall, after con16 sultation with stakeholders, establish 

17 thresholds, based on prescriber spe18 cialty and, as determined appropriate 

19 by the Secretary, geographic area, for 

20 identifying whether a prescriber in a 

21 specialty and geographic area is an 

22 outlier prescriber of opioids as com23 pared to other prescribers of opioids 

24 within such specialty and area. 


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1 ‘‘(III) EXCLUSIONS.—The fol2 lowing shall not be included in the 

3 process for identifying outlier pre4 scribers of opioids under this clause: 

5 ‘‘(aa) Claims for covered 

6 part D drugs for part D eligible 

7 individuals who are receiving hos8 pice care under this title. 

9 ‘‘(bb) Claims for covered 

10 part D drugs for part D eligible 

11 individuals who are receiving on12 cology services under this title. 

13 ‘‘(cc) Prescribers who are 

14 the subject of an investigation by 

15 the Centers for Medicare & Med16 icaid Services or the Office of the 

17 Inspector General of the Depart18 ment of Health and Human 

19 Services. 

20 ‘‘(iii) CONTENTS OF NOTIFICATION.— 

21 The Secretary shall include the following 

22 information in the notifications provided 

23 under clause (i): 

24 ‘‘(I) Information on how such 

25 prescriber compares to other preVerDate Sep 11 2014 02:21 May 30, 2018 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2920.IS S2920

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1 scribers within the same specialty 

2 and, if determined appropriate by the 

3 Secretary, geographic area. 

4 ‘‘(II) Information on opioid pre5 scribing guidelines, based on input 

6 from stakeholders, that may include 

7 the Centers for Disease Control and 

8 Prevention guidelines for prescribing 

9 opioids for chronic pain and guidelines 

10 developed by physician organizations. 

11 ‘‘(III) Other information deter12 mined appropriate by the Secretary. 

13 ‘‘(iv) MODIFICATIONS AND EXPAN14 SIONS.— 

15 ‘‘(I) FREQUENCY.—Beginning 5 

16 years after the date of the enactment 

17 of this subparagraph, the Secretary 

18 may change the frequency of the noti19 fications described in clause (i) based 

20 on stakeholder input and changes in 

21 opioid prescribing utilization and 

22 trends. 

23 ‘‘(II) EXPANSION TO OTHER

24 PRESCRIPTIONS.—The Secretary may 

25 expand notifications under this subVerDate Sep 11 2014 02:21 May 30, 2018 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2920.IS S2920

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1 paragraph to include identifications 

2 and notifications with respect to con3 current prescriptions of covered part 

4 D drugs used in combination with 

5 opioids that are considered to have 

6 adverse side effects when so used in 

7 such combination. 

8 ‘‘(v) ADDITIONAL REQUIREMENTS FOR

9 PERSISTENT OUTLIER PRESCRIBERS.—In 

10 the case of a prescriber who the Secretary 

11 determines is persistently identified under 

12 clause (ii) as an outlier prescriber of 

13 opioids, the following shall apply: 

14 ‘‘(I) The Secretary shall connect 

15 such prescriber with an entity that 

16 provides technical or educational re17 sources on opioid prescribing guide18 lines (such as the guidelines described 

19 in clause (iii)(II)), which may include 

20 a quality improvement organization 

21 under part B of title XI, as available 

22 and appropriate. 

23 ‘‘(II) Such prescriber may be re24 quired to enroll in the program under 

25 this title under section 1866(j) if such 


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1 prescriber is not otherwise required to 

2 enroll. The Secretary shall determine 

3 the length of the period for which 

4 such prescriber is required to main5 tain such enrollment. 

6 ‘‘(III) Not less frequently than 

7 annually (and in a form and manner 

8 determined appropriate by the Sec9 retary), the Secretary shall commu10 nicate information on such prescribers 

11 to sponsors of a prescription drug 

12 plan and Medicare Advantage organi13 zations offering an MA–PD plan. 

14 ‘‘(vi) PUBLIC AVAILABILITY OF IN15 FORMATION.—The Secretary shall make 

16 aggregate information under this subpara17 graph available on the Internet website of 

18 the Centers for Medicare & Medicaid Serv19 ices. Such information shall be in a form 

20 and manner determined appropriate by the 

21 Secretary and shall not identify any spe22 cific prescriber. In carrying out this clause, 

23 the Secretary shall consult with interested 

24 stakeholders. 


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1 ‘‘(vii) OPIOIDS DEFINED.—For pur2 poses of this subparagraph, the term 

3 ‘opioids’ has such meaning as specified by 

4 the Secretary. 

5 ‘‘(viii) OTHER ACTIVITIES.—Nothing 

6 in this subparagraph shall preclude the 

7 Secretary from conducting activities that 

8 provide prescribers with information as to 

9 how they compare to other prescribers that 

10 are in addition to the activities under this 

11 subparagraph, including activities that 

12 were being conducted as of the date of the 

13 enactment of this subparagraph.’’. 

Æ 


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