[Congressional Record (Bound Edition), Volume 162 (2016), Part 2]
[Senate]
[Pages 2159-2160]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STOPPING MEDICATION ABUSE AND PROTECTING SENIORS ACT

  Mr. TOOMEY. Mr. President, I rise this morning to address a huge 
problem that is happening in every one of our States and in all of our 
communities and to talk about a bill that is meant to be helpful in 
this area. It is about the huge problem we have with opioid abuse, 
opioid addiction, including both prescription and heroin addiction and 
abuse. This is an epidemic that is truly unbelievable in scale. It is 
affecting people of all ages, all ethnic groups, all demographics, all 
income classes, all geography. It is everywhere, and it is a huge 
problem. I have heard about it in every county I have visited in my 
State. In all 67 counties of Pennsylvania, I have heard about how big 
this problem is. In fact, more Pennsylvanians will die this year from 
heroin overdoses and the misuse of opioid painkillers than from the flu 
or homicides.
  I wanted to learn more about this, so last fall I convened a hearing 
of the Senate Finance Subcommittee on Health Care, which I chair. 
Senator Casey joined me in that hearing at Allegheny General Hospital 
in Pittsburgh, where we had this, to learn more to understand about the 
nature and scale of this huge opioid addiction problem and what we 
might do about it. I was surprised when I got to the room. It was a 
huge auditorium, and it was standing room only. The room was completely 
packed with people because this epidemic is affecting virtually every 
family. It affects almost all of us at some level and in some way. It 
is tearing families apart. It is taking the lives of people who are in 
the prime of their lives. It is a huge problem.
  The hearing was very helpful in illuminating some aspects of the 
nature of the problem. We had medical professionals who are dealing 
with the treatment, and we had people who are suffering from addiction. 
A recovering addict who has put her life back together told a very 
compelling story about what she went through. We had people in law 
enforcement. So we had a lot of testimony with different perspectives.
  One of the things I took away is that there are at least three 
categories of ways we can help try to deal with this huge scourge. One 
is the problem of the overprescription of narcotics, the 
overprescription of painkillers, opioids, which are chemically very 
similar to heroin. A lot of people begin their addiction with these 
prescriptions, and then when they can no longer obtain or afford the 
prescription opioids, they move on to nonprescription forms, such as 
heroin, and it usually goes downhill very dramatically from there. So 
reducing overprescription has to help. There are ways to deal with 
that. A second is to reduce the diversion of these opioids when they 
are being prescribed. My legislation really does focus on that. The 
third is, we need better treatment and we need better outreach. We need 
better ways of treating people. We need to treat the addiction, but 
also, many people find themselves addicted after they develop a mental 
health problem that is an underlying problem that contributes to the 
addiction. We have to do a better job identifying and helping people 
with mental health problems.
  We have many aspects to this challenge that arises from this terrible 
epidemic, but let me focus in on one aspect of this, the 
overprescription and the diversion of prescription narcotics.
  The Government Accountability Office estimated that in 1 year alone, 
there were 170,000 Medicare beneficiary enrollees engaged in doctor 
shopping. Doctor shopping is the process whereby a person goes to 
multiple doctors, gets multiple prescriptions for perhaps the same 
opioid--maybe oxycodone or some other kind of painkiller--then goes to 
multiple pharmacies to get them all filled and ends up walking out of 
the pharmacy with a huge quantity of these very powerful, very 
addictive opioids, which they then sell on the black market. It is a 
very valuable commodity on the black market. The GAO found that there 
was one beneficiary who visited 89 different doctors in a single year, 
all for the same kind of prescriptions. There is another beneficiary 
who received prescriptions for 1,289 hydrocodone pills. That is a 490-
day supply. You are not supposed to get more than a 30-day supply.
  The inspector general found that a midwestern pharmacy billed 
Medicare

[[Page 2160]]

for reimbursement of over 1,000 prescriptions for each of just 2 
beneficiaries--1,000 prescriptions per beneficiary--and one physician 
ordered all the prescriptions for one of those beneficiaries.
  Last April, the DEA indicted two doctors in Mobile, AL, who were 
writing prescriptions for massive amounts of pain pills that were then 
filled at the pharmacy next door to the pain clinic they also owned.
  The examples go on and on. This is fraud. Let's be clear that that is 
what it is. This is fraud. This is people who are systemically abusing 
these programs so they can obtain commercial-scale quantities of a very 
valuable narcotic, which is also very dangerous and very addictive, 
because it can be lucrative. Why is it lucrative? In part, because the 
American taxpayer pays for their supply. That is how outrageous this 
is. People are getting multiple prescriptions, going to multiple 
pharmacies, and when the prescription is filled at all of these 
pharmacies on these multiple occasions, the bill is submitted to 
Medicare, and Medicare reimburses.
  Think about this. We have this criminal enterprise where the supply 
of narcotics is being paid for by taxpayers, and then the people who 
fraudulently obtain these drugs go out and sell them in what I am sure 
is a very lucrative arrangement. This is beyond outrageous; It is the 
description of the obviously fraudulent.
  There is another category of people who end up with multiple 
prescriptions and it is completely innocent. There is no criminal 
intent whatsoever, no criminal activity. It is especially elderly 
people who have multiple illnesses and they have different doctors who 
treat them. In many cases, there is not a good coordination of the care 
for those patients. There is nobody coordinating what all of the 
doctors are doing, so doctors separately and--if it weren't for what 
other doctors are doing--appropriately give a prescription for a 
powerful narcotic. They don't know there is another doctor doing the 
same thing. This patient unwittingly ends up with an excessive quantity 
of these opioids, which dramatically increases the risk that the 
patient will become addicted and will suffer any number of very harmful 
consequences.
  So we have the fraudulent cases of excessive prescriptions and then 
we have the innocent cases, but both are problems. The legislation I 
have introduced addresses both problems. First, I want to thank the 
cosponsors, the coauthor of the bill. Senator Sherrod Brown from Ohio 
is the lead Democrat on this bill. It is a bipartisan bill. Senator 
Portman and Senator Kaine have also been very helpful. They are 
original cosponsors of the bill. It is called Stopping Medication Abuse 
and Protecting Seniors Act. We now have 25 cosponsors.
  We had a very constructive hearing last week in the Senate Finance 
Committee about this legislation, this approach. Senator Hatch said he 
hopes the bill will move very soon. I hope the bill will move very 
soon. It is very important.
  Here is what it does. When Medicare discovers that a beneficiary is 
obtaining multiple prescriptions well beyond what any individual should 
appropriately have, then Medicare would have the authority to require 
that person to get their prescriptions in the future from one doctor 
and get it filled at one pharmacy. It is called lock-in because you are 
locked in to a single doctor and you are locked in to a single 
pharmacy. In one step, that would go a very long way to making it very 
difficult to commit this kind of fraud or to accidentally obtain more 
prescriptions than you ought to have.
  This procedure is not a new concept. It already exists in Medicaid. 
It is used every day in Medicaid to protect innocent people from 
excessive prescriptions and to protect taxpayers from fraudulent abuse. 
It is done by private carriers all the time. Private health insurance 
carriers use this lock-in mechanism when they discover excessive 
prescriptions being written. It is designed in a way--as these other 
programs are, the private and Medicaid--so that no one who legitimately 
needs a prescription--because there are legitimate prescriptions for 
opioids and for narcotics. No one who has a legitimate need will have 
an access problem. People will still be able to obtain exactly what 
they need. The lock-in applies only to a narrow category of controlled 
substances, schedule II controlled substances, which is what we think 
is appropriate.
  I think this is going to be very helpful. It is going to help opioid-
addicted seniors be identified as such so they can get the treatment 
they need. It is going to stop the diversion of these powerful 
narcotics. It is going to save taxpayers money. CBO estimates that $79 
million over 10 years will be saved by bringing an end to these illegal 
prescriptions. And it is going to reduce the quantity of these terribly 
powerful drugs on the streets.
  This legislation has very broad bipartisan support. Just last weekend 
the National Governors Association came out fully in favor of adding a 
lock-in provision for Medicare. We had nearly identical language passed 
in a bill in the House as part of the 21st-century cures legislation, 
which passed overwhelmingly. The support includes the President of the 
United States. His budget has repeatedly asked Congress to give 
Medicare this authority. CMS's Acting Administrator, Andy Slavitt, just 
recently, before our committee, said this legislation makes ``every bit 
of sense in the world.'' We have the support of the CDC Director; the 
White House drug czar; Pew Charitable Trusts; Physicians for 
Responsible Opioid Prescribing; many law enforcement groups; senior 
groups, such as the Medicare Rights Center. This is a list of just some 
who support this legislation.
  This is really just common sense. We already have this capability in 
Medicaid. We already have this capability in private health insurance. 
It is long past due that Medicare have the ability to protect seniors 
from accidental excessive prescriptions but also to prevent people from 
committing fraud, which we know is happening on a very large scale 
today.
  I am not aware of any opposition to this. We have broad bipartisan 
support. I am hoping we can get this passed very soon, certainly in the 
next week or so. The House will certainly pass this, as it already has 
as part of the 21st-century cures legislation, and we can get this to 
the President and get this signed into law and start to help save lives 
and save taxpayers money at the same time.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.

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