The CMS hopes it will soon have a new tool to combat the opioid epidemic: the ability to lock in beneficiaries to a single prescriber of frequently abused drugs, a senior agency official told Congress on Wednesday.
The CMS has proposed a policy to prevent Medicare beneficiaries from obtaining prescription drugs from multiple doctors or pharmacies, locking them in to one pharmacy or prescriber for Medicare Part D benefits if they're considered at-risk for opioid misuse or abuse.
Prescriber lock-in would limit an at-risk beneficiary's access to coverage for frequently abused drugs to those that are prescribed by a specified pharmacy or provider.
The CMS formally plans to launch the policy in 2019 and received comments on the proposed rulemaking through Jan. 16.
"We believe this approach will improve quality of care through enhanced coordination, while maintaining access to necessary pain medications," Kimberly Brandt, principal deputy administrator for operations at the CMS said at a House Ways and Means Oversight Subcommittee hearing Wednesday.
Locking in Medicare beneficiaries to one pharmacy or provider will make it easier to track billing patterns, according to Brandt. Currently, enrollees can go to multiple places or providers to pick up or be prescribed medications, she said.
Health insurance companies and pharmacy stakeholders have supported the initiative in comments to the agency, but they hope the CMS will make some tweaks to the policy before its rolled out.
For instance, Priority Health, a Michigan-based health plan, wants the agency to move away from the proposed requirement to wait six months prior to limiting a beneficiary's access to addictive drugs, as a beneficiary's plan may only be active for twelve months.
"Inappropriate utilization of frequently abused drugs should and can be addressed more efficiently," the company said in a comment letter.
Priority Health instead suggested allowing the policy to kick in around the three-month mark.
Health Partners Plans, a Pennsylvania-based plan, is concerned that the lock-in could only occur after obtaining an agreement from that person's provider or pharmacy prescribing the drugs.
"Gaining agreement from prescribers or pharmacies will cause delays in beneficiary lock-in, and will require follow-up with prescribers to gain agreement, and repeat the process if the first prescriber does not consent," plan officials said in a comment letter.
The Independent Pharmacy Cooperative, which represents more than 2600 independent community pharmacies across the country, wants language put in to the final version of the rule that prohibits plans from locking in beneficiaries at pharmacies in which they have an ownership interest.
The Northeast Pharmacy Service Corporation, an industry advocacy organization, wants the CMS to clarify to consumers that the proposed lock-in wouldn't be for all drugs.
"[We] want to make sure that any notice sent to patients makes very clear that any lock-in program applies only to frequently abused drugs."
