The Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule on January 7 that would revise the Medicare Advantage program (also known as Medicare Part C) and the prescription drug benefit program (Part D) regulations. The change would prohibit physicians who are not enrolled in Medicare from being paid for prescribing drugs under Medicare Part D.
The rule would require providers to enroll in Medicare in order to prescribe Medicare Part D drugs; the requirement would start next year.
The rule would also provide for stricter oversight of the prescription of pain medication and also allow CMS to revoke a doctor’s Medicare enrollment if his or her registration with the US Drug Enforcement Administration is suspended. CMS could also revoke the enrollment of any provider prescribing drugs in “reckless disregard for the health and safety of the patient.” The rule does not include a definition of what would constitute abusive prescribing; CMS would consider numerous factors before taking action.
This proposed rule follows an OIG report published last June (and summarized here), outlining a study that found that a group of approximately 700 physicians were responsible for prescribing over $350 million worth of Part D prescription drugs in 2009. Many of the physicians with questionable prescribing patterns prescribed extremely high numbers of prescriptions per beneficiary, which may indicate that some prescriptions were medically unnecessary. Additionally, more than half of the physicians identified prescribed extremely high percentages of Schedule II or III drugs, which have the potential for addiction and abuse.
The full proposed rule can be accessed here here. Comments on the rule may be submitted until March 7, 2014. Comments may be submitted electronically at http://www.regulations.gov/. Comments should refer to file code CMS-4159-P.