This Week's News
AMA to CMS: Don't let Medicare drug plans deny prescription coverage
A proposal intended to curb prescription drug abuse could instead prevent Medicare patients from receiving medications prescribed by their physicians, the AMA warned the Centers for Medicare & Medicaid Services (CMS) in a letter last week.
Under CMS's proposal, Medicare drug plans would be permitted to deny Medicare Part D medication coverage to patients they suspect of prescription abuse. The AMA is concerned that this approach could cause hardship for patients who are appropriately seeking medical treatment.
"Physicians, not health insurers, have the expertise to make decisions about which medications a patient should receive," AMA President Peter W. Carmel, MD, said in a news release. "Medicare patients who are seriously ill or in severe pain should not be unjustly denied the medications prescribed by their physician."
While the AMA agrees that misuse of prescription drugs is a serious concern, the letter explained that Medicare drug plans have access only to patients' insurance claims for Part D drugs and do not have the information or clinical expertise necessary to judge whether patients may be abusing medications.
Instead, the AMA suggested that the drug plans provide the insurance claim information to patients' prescribing physicians so they are in a position to determine whether all the prescriptions are appropriate and reconcile the multiple medications.
The AMA also strongly supports increased funding for drug-monitoring programs and real-time prescription information for physicians at the point of care.
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