Today, Medicare Advocacy Recovery Coalition (MARC) Chairman Greg McKenna submitted a comment letter to CMS Administrator Seema Verma in response to the proposed rule entitled "Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program." In the letter, Chairman McKenna applauded CMS' initiatives to address the nation's opioid epidemic, and stressed that CMS must to ensure that frequently abused drugs are appropriately managed so that Medicare beneficiaries at risk of abuse and addiction cannot access them through the Part D program. "We write today to urge CMS in both its final rule and in the final rule preamble to address how frequently abused drugs could be accessed through Workers Compensation Medicare Set Aside arrangements (MSAs)," wrote Chairman McKenna.
Chairman McKenna also stated: "As CMS is aware, during the MSA process CMS reviews Medicare Secondary Payer proposals for future care, and advises beneficiaries on proposed plans of care. Unfortunately, at a time when the entire federal government is working to curb opioid use, CMS in the MSA process is inadvertently suggesting use be expanded. More specifically, following the submission of MSAs to CMS by beneficiaries or those funding beneficiary care, the Agency often proposes back modifications to care plans. In many cases a beneficiary may need some pain medications, such as an opioid– which if used beyond their medically necessary requirements can lead to addiction and other abuse. Unfortunately, the routine and consistent practice of CMS is to require MSA payment for lifetime use of highly potent and frequently abused drugs. These CMS recommendations are far beyond any evidenced-based guideline recommendations, and could cause harm to the beneficiaries involved if they misconstrue the CMS recommendations as federally sanctioned treatment guidelines or requirements."
The comment letter in its entirety is attached below.