Medicare Drug Plans May Get Authorization System Update

The House on Wednesday passed H.R. 5773, a bill requesting technological changes that may lead to an overhaul for the Medicare drug plan prescription preauthorization process, reports ThinkAdvisor . One section of the Preventing Addiction for Susceptible Seniors Act of 2018 urges the secretary of the U.S. Department of Health and Human Services (HHS) to have electronic preauthorization system for Medicare Advantage plans and Medicare Part D prescription drug plans implemented by Jan. 1, 2021. Another section would call for encouraging Medicare Advantage plans and Medicare Part D drug plans should to expand use of electronic preauthorization systems. The bill says expanding usage of the systems should "reduce access delays, by resolving coverage issues before prescriptions for such drugs are transmitted." The legislation also would require Medicare plans to make high-risk enrollees eligible for medication therapy management program benefits by Jan. 1, 2021, and mandate the HHS secretary develop a program to warn Medicare Part D prescribers if the providers were prescribing more opioids than comparable providers. In addition, the HHS secretary would be required to establish a website that Medicare drug plans could use to share information about possible fraud, waste, and abuse with the department and each other. Mark Farrah Associates estimates that about 43.5 million Americans have drug benefits from a Medicare Advantage plan or a Medicare Part D drug plan.