SEC. 2. MEDICARE NOTIFICATIONS TO OUTLIER PRE-
SCRIBERS OF OPIOIDS. 
Section 1860D–4(c)(4) of the Social Security Act (42 
U.S.C. 1395w–104(c)(4)) is amended by adding at the end 
the following new paragraph: 
‘‘(D) OUTLIER
PRESCRIBER
NOTIFICA-
TION.— 
‘‘(i) NOTIFICATION.—Beginning not 
later than two years after the date of the 
enactment of this subparagraph, the Sec-
retary shall, in the case of a prescriber 
identified by the Secretary under clause 
(ii) to be an outlier prescriber of opioids, 
provide, subject to clause (iv), an annual 
notification to such prescriber that such 
prescriber has been so identified and that 
includes resources on proper prescribing 
methods and other information specified in 
accordance with clause (iii). 
‘‘(ii) IDENTIFICATION
OF
OUTLIER 
PRESCRIBERS OF OPIOIDS.— 
‘‘(I) IN
GENERAL.—The Sec-
retary shall, subject to subclause (III), 
using the valid prescriber National 
Provider Identifiers included pursuant 
to subparagraph (A) on claims for 
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covered part D drugs for part D eligi-
ble individuals enrolled in prescription 
drug plans under this part or MA–PD 
plans under part C and based on the 
threshold established under subclause 
(II), conduct an analysis to identify 
prescribers that are outlier opioid pre-
scribers for a period specified by the 
Secretary. 
‘‘(II) 
ESTABLISHMENT
OF 
THRESHOLD.—For purposes of sub-
clause (I) and subject to subclause 
(III), the Secretary shall, after con-
sultation with stakeholders, establish 
a threshold, based on prescriber spe-
cialty and geographic area, for identi-
fying whether a prescriber in a spe-
cialty and geographic area is an 
outlier prescriber of opioids as com-
pared to other prescribers of opioids 
within such specialty and area. 
‘‘(III) EXCLUSIONS.—The Sec-
retary may exclude the following indi-
viduals and prescribers from the anal-
ysis under this clause: 
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‘‘(aa) Individuals receiving 
hospice services. 
‘‘(bb) Individuals with a 
cancer diagnosis. 
‘‘(cc) Prescribers who are 
the subject of an investigation by 
the Centers for Medicare & Med-
icaid Services or the Office of In-
spector General of the Depart-
ment of Health and Human 
Services. 
‘‘(iii) CONTENTS OF NOTIFICATION.— 
The Secretary shall, based on input from 
stakeholders, specify the resources and 
other information to be included in notifi-
cations provided under clause (i). 
‘‘(iv) MODIFICATIONS
AND
EXPAN-
SIONS.— 
‘‘(I) FREQUENCY.—Beginning 5 
years after the date of the enactment 
of this subparagraph, the Secretary 
may change the frequency of the noti-
fications described in clause (i) based 
on stakeholder input. 
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‘‘(II) 
EXPANSION
TO
OTHER 
PRESCRIPTIONS.—The Secretary may 
expand notifications under this sub-
paragraph to include identifications 
and notifications with respect to con-
current prescriptions of covered Part 
D drugs used in combination with 
opioids that are considered to have 
adverse side effects when so used in 
such combination, as determined by 
the Secretary. 
‘‘(v) OPIOIDS
DEFINED.—For pur-
poses of this subparagraph, the term 
‘opioids’ has such meaning as specified by 
the Secretary through program instruction 
or otherwise.’’. 
Æ 
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