Medicare Prescription Drug Abuse Prevention Act of 2016

Bill: 114-hr-4876
Sponsor: Rep. Meehan, Patrick [R-PA-7]
Introduced: 2016-03-23 in the House
Policy area: Health
Subjects: Administrative law and regulatory procedures
Congressional oversight
Consumer affairs
Department of Health and Human Services
Drug trafficking and controlled substances
Drug, alcohol, tobacco use
Fraud offenses and financial crimes
Government studies and investigations
Health care coverage and access
Health information and medical records
Health technology, devices, supplies
Medicare
Performance measurement
Prescription drugs

Summary:
action_date: 2016-03-23
text: 

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.


Legislative actions:
action_date: 2016-03-29
text: Referred to the Subcommittee on Health.
action_date: 2016-03-25
text: Referred to the Subcommittee on Health.
action_date: 2016-03-23
text: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2016-03-23
text: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2016-03-23
text: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2016-03-23
text: Introduced in House
action_date: 2016-03-23
text: Introduced in House