Senators Push to Keep Seniors From Doctor Shopping for Opioids

Bipartisan legislation aimed at blocking Medicare recipients from shopping for doctors and pharmacists likely to prescribe opioids could help address the national prescription drug abuse epidemic, Senate Finance Committee Democrats said at a hearing Tuesday. But they urged Republicans to broaden their approach to encourage more addiction treatment.

“As the committee that’s required to pay for the most important health programs in the nation, the Finance Committee needs to do its part to address the opioid crisis,” said the panel's top Democrat, Ron Wyden of Oregon. “In my view, a key piece of the puzzle has to be prompt and effective treatment of those who are dealing with an addiction to opioids.”

Medicare, the federal health program for the elderly and disabled, and Medicaid, the federal-state health program for the poor, are projected to account for more than a third of all U.S. spending on substance abuse. The programs' payment policies often influence private insurance coverage.

The hearing focused on a plan (S 1913) from Pennsylvania Republican Patrick J. Toomey that would allow health plans to restrict at-risk Medicare beneficiaries to a limited number of pharmacies and providers when the patients seek medications. Senate Finance Chairman Orrin G. Hatch, R-Utah, said the committee would mark up the bill "very soon" and expressed some frustration with Democrats' concerns about the effort. 

“I have always worked with the ranking member to select witnesses in order to ensure a balanced panel in each committee hearing,” said Hatch, who pointed out that one of the witnesses hailed from Wyden’s home state of Oregon. “It’s difficult for me to imagine why anyone would be expressing disappointment.”

However, New Jersey Democrat Robert Menendez, maintained that the panel did not reflect a broad range of views on how to combat prescription drug and heroin abuse.

“I’m troubled by the fact we don’t have any witnesses here today to speak specifically on the issues of addiction treatment and recovery,” he said.

Tuesday’s hearing comes amid increasing congressional action on drug addiction. The Senate Judiciary Committee advanced a pair of bills earlier this month, including a wide-ranging package (S 524) from Sheldon Whitehouse, D-R.I., and Rob Portman, R-Ohio, that is expected to be brought to the Senate floor as early as next week.

But Democrats have been pushing to attach $600 million in emergency supplemental funding to the Portman legislation, expressing frustration that the bill only authorizes new spending while not actually allocating the funds.

Lock-In Programs

The so-called lock-in programs in Toomey's bill that restrict patients' access to pharmacies and physicians are designed to curb prescription opioid abuse by preventing “doctor shopping” and improving the coordination of care. A patient receiving certain narcotics could only get those prescriptions from a designated physician or pharmacist. Similar lock-in language was included in a House-passed biomedical innovation bill (HR 6) last year. Medicaid already has the authority to impose such restrictions.

“There’s two specific things we can do that is the responsibility of this committee, and our bill addresses these things: efforts to reduce overprescribing, and an effort to reduce the diversion of these powerful, prescribed narcotics,” Toomey said.

Lawmakers in both parties agreed Tuesday that expanding lock-in programs to Medicare would save lives and money by eliminating fraudulent and unnecessary prescription payments. But Wyden argued that the panel also needs to focus on treating those who may be addicted to painkillers, because such individuals could turn to heroin when they can no longer obtain a prescription – a trend that has helped fuel the opioid epidemic.

“When you actually restrict access to opioids, it is absolutely critical that you step up treatment because everybody in health care is telling us the addiction is not just automatically going away,” Wyden said. “I’m just going to be hammering that point away again and again as we talk in the days ahead about how to tackle this.”

Portman emphasized that his drug addiction package headed to the Senate floor already addresses some of those concerns. “This broader bill does deal with what Senator Wyden talked about: prevention, treatment, recovery, enforcement,” Portman said.

His plan would expand educational and prevention efforts, increase access to drugs that can reverse the effects of overdoses and launch evidence-based treatment and intervention programs. The measure also would give states incentives to strengthen prescription drug-monitoring programs, which can help track at-risk individuals and track prescription drug diversion.

Portman also pointed out that the lock-in provisions in Toomey’s bill can help identify at-risk beneficiaries who need treatment for an addiction.

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