Should Medicare Prescription Drug Plans be Allowed to Suspend Payments to Pharmacies Accused of Fraud? (H.R. 5676)

What is H.R. 5676?

(Updated September 24, 2018)

This bill — the SENIOR Communities Protection Act — would authorize the suspension of payments by Medicare Prescription Drug Plans and Medicare Advantage to a pharmacy pending the investigation of credible allegations of fraud against the pharmacy. A fraud hotline tip, without other evidence, couldn’t be considered a credible allegation of fraud. The Dept. of Health and Human Services (HHS) has similar authority under Medicare Fee-for-Service, and the HHS Inspector General would be required to investigate allegations under this bill.

The bill’s full title is the Stop Excessive Narcotics in Our Retirement (SENIOR) Communities Protection Act.

Argument in favor

This commonsense, bipartisan bill would ensure that pharmacies accused of fraud stop receiving payments under Medicare Advantage and Medicare Prescription Drug Plans while they’re investigated.

Argument opposed

While pharmacies facing substantive allegations of fraud need to be investigated, suspending payments to them under Medicare prescription drug plans goes too far and won't serve as a deterrent.

Impact

Pharmacies accused of fraud; Medicare Advantage and Medicare Prescription Drug Plans; and the HHS IG.

Cost of H.R. 5676

The CBO estimates that enacting this bill would decrease Medicare Part D spending by $9 million over the 2019-2028 period.

Additional Info

In-Depth: Sponsoring Rep. Tom MacArthur (R-NJ) introduced this bill, which passed the House Ways and Means Committee on a voice vote and has the support of five bipartisan cosponsors — including three Democrats and two Republicans.

Media:

• House Ways and Means Committee Summary
  
• Republican Policy Committee
  
• CBO Cost Estimate