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Medicare Drug Plans May Get Authorization System Update

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Members of the House have approved a bill, H.R. 5773, that could eventually lead to a revamp of the Medicare drug plan prescription preauthorization process.

House members passed the “Preventing Addiction for Susceptible Seniors Act of 2018″ (PASS Act of 2018) bill Wednesday, by a voice vote.

The House Ways and Means Committee considered the bill, which was introduced by Rep. Pete Roskam, R-Ill., along with a flurry of other bills aimed at addressing the opioid abuse crisis.

(Related: CVS, Aetna Increase Medicare Drug Plan Enrollee Share: Mark Farrah)

One section of the bill calls for the secretary of the U.S. Department of Health and Human Services to put an electronic preauthorization system for Medicare Advantage plans and Medicare Part D prescription drug plans in place by Jan. 1, 2021.

Another section would express the sense of Congress that Medicare Advantage plans and Medicare Part D drug plans should be encouraged to expand use of electronic preauthorization systems.

Increasing using of electronic preauthorization systems should “reduce access delays, by resolving coverage issues before prescriptions for such drugs are transmitted,” according to the bill text.

Other sections of H.R. 5773 would:

  • Require Medicare plans to make high-risk enrollees eligible for medication therapy management program benefits by Jan. 1, 2021.
  • Require the HHS secretary to develop a program that would warn Medicare Part D prescribers if the providers were prescribing more opioids than comparable providers.
  • Require the HHS secretary to set up a website that Medicare drug plans could use to share information about possible fraud, waste and abuse with HHS and with one another.

Any legislation that affects Medicare drug plans could eventually affect the commercial health insurance, because of the vast size of the Medicare drug plan program. About 43.5 million U.S. residents have drug benefits from a Medicare Advantage plan or a Medicare Part D drug plan, according to Mark Farrah Associates.

— Read Medicare Plan Sales Clobbered Full-Cost Individual Medical: eHealthon ThinkAdvisor.

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