House passes Medicare Part D electronic prior authorization bill

Legislation also establishes secure Internet portal to enable Medicare Advantage and Part D plans to exchange information about fraud, waste and abuse.

The House of Representatives on Tuesday unanimously passed legislation requiring healthcare professionals to submit prior authorization requests electronically for drugs covered under Medicare Part D.

The Preventing Addiction for Susceptible Seniors (PASS) Act of 2018 (H.R. 5773), sponsored by Chairman of the House Ways and Means Health Subcommittee Rep. Peter Roskam (R-Ill.), is an amalgamation of multiple previously introduced opioid-related bills, including provisions of the Standardizing Electronic Prior Authorization for Safe Prescribing Act (H.R. 4841), which was originally introduced by Rep. David Schweikert (R-Ariz.).

Health IT Now’s Opioid Safety Alliance, a working group of prescribers, dispensers, professional societies and patients advocating for the use of technology to fight the illegitimate use of opioids, applauded the House passage of the PASS Act.

“Electronic prior authorization (ePA) is already working in the commercial market to streamline PA claims and ensure legitimate beneficiary access to prescribed medications while preventing misuse and abuse of medication under PA, such as many opioids. It is only common sense that we would finally bring this same technology into the Medicare space,” said Joel White, executive director of the HITN Opioid Safety Alliance. “Health IT Now’s Opioid Safety Alliance thanks Representatives Roskam, Schweikert and our many other champions on Capitol Hill for their work to secure House passage of this important solution and urges the Senate to quickly follow suit.”

Last month, the Electronic Prior Authorization in Medicare Part D Act was introduced in the Senate by Sens. Pat Roberts (R-Kan.), Tom Carper (D-Del.), and Chuck Grassley (R-Iowa), calling for the use of ePA through a common electronic system so that patients can receive faster access to alternatives to opioid medications for chronic and acute pain, as well as improved access to medication-assisted treatment to treat opiate addiction.

Also See: Senate bill calls for Medicare Part D electronic prior authorization

In addition to electronic prior authorization, the legislation includes several other provisions meant to combat the national opioid epidemic.

The PASS Act requires Part D prescription drug plans to provide drug management programs for Medicare beneficiaries who are at risk for prescription drug abuse. Under current law, Part D plans are permitted but not required to establish such programs. The bill also expands medication therapy management programs under Part D to include beneficiaries who are at risk for prescription drug abuse.

Another provision requires the Secretary of Health and Human Services on an annual basis to notify high prescribers of opioids and furnish them with information about proper prescribing methods. The PASS Act also requires the HHS Secretary to establish a secure Internet portal to allow HHS, Medicare Advantage plans, and Medicare Part D plans to exchange information about fraud, waste, and abuse among providers and suppliers no later than two years after enactment.

The legislation also requires organizations with Medicare Advantage contracts to submit information on investigations related to providers suspected of prescribing large volumes of opioids through a process established by the HHS Secretary.

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