Stopping Medication Abuse and Protecting Seniors Act of 2015

Summary

Stopping Medication Abuse and Protecting Seniors Act of 2015 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.

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3 official files

• Introduced in Senate (text)

  Introduced in Senate · EN · 30 July 2015

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• Introduced in Senate (PDF)

  Introduced in Senate · EN · 30 July 2015

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• Introduced in Senate

  summary · EN · 30 July 2015

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