301 
‘‘(E) A utilization management tool to pre-
vent drug abuse (as described in paragraph 
(6)(A)).’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(6) UTILIZATION MANAGEMENT TOOL TO PRE-
VENT DRUG ABUSE.— 
‘‘(A) IN
GENERAL.—A tool described in 
this paragraph is any of the following: 
‘‘(i) A utilization tool designed to pre-
vent the abuse of frequently abused drugs 
by individuals and to prevent the diversion 
of such drugs at pharmacies. 
‘‘(ii) Retrospective utilization review 
to identify— 
‘‘(I) individuals that receive fre-
quently abused drugs at a frequency 
or in amounts that are not clinically 
appropriate; and 
‘‘(II) providers of services or sup-
pliers that may facilitate the abuse or 
diversion of frequently abused drugs 
by beneficiaries. 
‘‘(iii) Consultation with the contractor 
described in subparagraph (B) to verify if 
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302 
an individual enrolling in a prescription 
drug plan offered by a PDP sponsor has 
been previously identified by another PDP 
sponsor as an individual described in 
clause (ii)(I). 
‘‘(B) REPORTING.—A PDP sponsor offer-
ing a prescription drug plan (and an MA orga-
nization offering an MA–PD plan) in a State 
shall submit to the Secretary and the Medicare 
drug integrity contractor with which the Sec-
retary has entered into a contract under section 
1893 with respect to such State a report, on a 
monthly basis, containing information on— 
‘‘(i) any provider of services or sup-
plier described in subparagraph (A)(ii)(II) 
that is identified by such plan sponsor (or 
organization) during the 30-day period be-
fore such report is submitted; and 
‘‘(ii) 
the 
name 
and 
prescription 
records of individuals described in para-
graph (5)(C).’’. 
(c) EXPANDING ACTIVITIES OF MEDICARE DRUG IN-
TEGRITY CONTRACTORS (MEDICS).— 
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303 
(1) IN GENERAL.—Section 1893 of the Social 
Security Act (42 U.S.C. 1395ddd) is amended by 
adding at the end the following new subsection: 
‘‘(j) EXPANDING ACTIVITIES OF MEDICARE DRUG 
INTEGRITY CONTRACTORS (MEDICS).— 
‘‘(1) ACCESS
TO
INFORMATION.—Under con-
tracts entered into under this section with Medicare 
drug integrity contractors, the Secretary shall au-
thorize such contractors to directly accept prescrip-
tion and necessary medical records from entities 
such as pharmacies, prescription drug plans, MA– 
PD plans, and physicians with respect to an indi-
vidual in order for such contractors to provide infor-
mation relevant to the determination of whether 
such individual is an at-risk beneficiary for prescrip-
tion drug abuse, as defined in section 1860D– 
4(c)(5)(C). 
‘‘(2) REQUIREMENT
FOR
ACKNOWLEDGMENT 
OF REFERRALS.—If a PDP sponsor or MA organiza-
tion refers information to a contractor described in 
paragraph (1) in order for such contractor to assist 
in the determination described in such paragraph, 
the contractor shall— 
‘‘(A) acknowledge to the sponsor or organi-
zation receipt of the referral; and 
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304 
‘‘(B) in the case that any PDP sponsor or 
MA organization contacts the contractor re-
questing to know the determination by the con-
tractor of whether or not an individual has been 
determined to be an individual described such 
paragraph, shall inform such sponsor or organi-
zation of such determination on a date that is 
not later than 15 days after the date on which 
the sponsor or organization contacts the con-
tractor. 
‘‘(3) MAKING DATA AVAILABLE TO OTHER EN-
TITIES.— 
‘‘(A) IN GENERAL.—For purposes of car-
rying out this subsection, subject to subpara-
graph (B), the Secretary shall authorize MED-
ICs to respond to requests for information from 
PDP sponsors and MA organizations, State 
prescription drug monitoring programs, and 
other entities delegated by such sponsors or or-
ganizations using available programs and sys-
tems in the effort to prevent fraud, waste, and 
abuse. 
‘‘(B) HIPAA COMPLIANT
INFORMATION 
ONLY.—Information may only be disclosed by a 
MEDIC under subparagraph (A) if the disclo-
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305 
sure of such information is permitted under the 
Federal regulations (concerning the privacy of 
individually identifiable health information) pro-
mulgated under section 264(c) of the Health 
Insurance Portability and Accountability Act of 
1996 (42 U.S.C. 1320d–2 note).’’. 
(2) OIG STUDY AND REPORT ON EFFECTIVE-
NESS OF MEDICS.— 
(A) STUDY.—The Inspector General of the 
Department of Health and Human Services 
shall conduct a study on the effectiveness of 
Medicare drug integrity contractors in identi-
fying combating, and preventing fraud under 
the Medicare program, including under the au-
thority provided under section 1893(j) of the 
Social Security Act, added by paragraph (1). 
(B) REPORT.—Not later than 1 year after 
the date of the enactment of this Act, the In-
spector General shall submit to Congress a re-
port on the study conducted under subpara-
graph (A). Such report shall include such rec-
ommendations for improvements in the effec-
tiveness of such contractors as the Inspector 
General determines appropriate. 
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