PCMA’s plan to curb Rx drug abuse, Medicare fraud

July 29, 2013

The Pharmaceutical Care Management Association has asked Congress to consider policy changes it believes will reduce prescription drug abuse and Medicare fraud.

The Pharmaceutical Care Management Association (PCMA) has asked Congress to consider policy changes it believes will reduce prescription drug abuse and Medicare fraud.

PCMA’s Safe Rx Initiative is five steps that would make it more difficult for drug seekers to fill fraudulent prescriptions. “As simple as it may sound, the key is to prevent abusers from actually acquiring controlled substances at the drugstore counter,” said Mark Merritt, PCMA president and CEO. “While it is difficult to stop abusers from ‘doctor shopping’ for prescriptions among hundreds of thousands of prescribers, it is much easier to keep them from gaining physical custody of narcotics and other controlled substances.” 

The National Community Pharmacists Association (NCPA) said it supports a collective effort to control abuse and diversion that involves patients, pharmacists, pharmacy benefit managers, wholesalers, manufacturers, and prescribers.

A statement from NCPA said, “At the forefront of prevention efforts must be a focus on reducing inappropriate prescribing of controlled substances and prevention of doctor shopping. After all without the prescription, a prescription drug abuser cannot advance any further through the legitimate health system, such as to a pharmacy.”

Prescription drug abuse and fraud are epidemic problems. According to the Centers for Disease Control and Prevention, the problems cost 20,000 lives and $72 billion dollars annually. They also fuel violent pharmacy robberies across the nation.

PCMA’s five steps, outlined in a letter to Congress, are:

ŸŸŸ1. Designate specific pharmacies in Part D to dispense controlled substances. PCMA believes this will maintain beneficiary access to needed medications, but prevent “drugstore shopping.”

Ÿ2. Mandate all pharmacies and pharmacists register with state drug-monitoring programs.

3. Allow payers access to state drug-monitoring databases. PCMA believes payer access to monitoring databases will help payers spot patterns of abuse. PCMA says many fraudulent sales go undetected because they are cash transactions.

Ÿ4. Medicare Parts A and B (and Medicaid) plans have stronger authority to detect fraud and suspend payments before claims are paid.

Ÿ5. Create uniform federal ‘track and trace’ standards. PCMA believes Congress should authorize a national system that tracks prescription drugs throughout the supply chain.

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