The American Medical Association (AMA) sent a letter on March 2 to the Centers for Medicare and Medicaid Services (CMS) asking them to change provisions that allow Medicare drug plans to deny drug coverage to patients when they suspect prescription misuse. The AMA told CMS that the proposed policy, aimed at combating misuse of prescription drugs, would instead prevent patients from receiving Medicare Part D coverage for medications prescribed to them by their physician.
“CMS must withdraw this flawed proposal that would give health insurers the ability to overrule physicians’ medical decisions and jeopardize the health of Medicare patients,” said AMA President Peter W. Carmel, MD. “Physicians, not health insurers, have the expertise to make decisions about which medications a patient should receive.”
To prevent the misuse of prescription drugs, the AMA urged CMS to instead encourage health insurers to fully share information so prescribing physicians will know all of a patients’ medications. The AMA has also strongly supported efforts to increase funding for the adoption of prescription drug monitoring programs, as well as for upgrades that provide real time prescription information to physicians at the point of care.
“We strongly agree with CMS that misuse of prescription drugs is a serious concern, but giving health insurers the ability to stop covering medications prescribed by a physician is not the answer,” said Dr. Carmel. “Preventing medication misuse should not cause hardship for those who are appropriately seeking medical treatment. Medicare patients who are seriously ill or in severe pain should not be unjustly denied the medications prescribed by their physician.”