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Drug executives to testify before Congress about their role in U.S. opioid crisis Current and former executives with the pharmaceutical distributors that are accused of flooding communities with powerful prescription painkillers have been summoned to testify before Congress about their role in the U.S. opioid epidemic. The hearing, scheduled for May 8 before a House Energy and Commerce Committee oversight panel, has the potential to be a defining moment for the pharmaceutical industry, much like when tobacco executives were called to testify before Congress in 1994. The pharmaceutical executives are expected to face tough questions under oath about why their

companies pumped so many highly addictive pain pills into West Virginia and other states, fueling what has become the deadliest drug crisis in U.S. history. Since 2000, the epidemic has killed 200,000 people — more than three times the number of U.S. military deaths in the Vietnam War. “It’s time to directly question the leadership of national and regional drug distributors whom we have probed for critical information,” Energy and Commerce Committee Chairman Greg Walden (R-Ore.) said in a statement. Executives from distributors McKesson Corp., Cardinal Health, AmerisourceBergen, Miami-Luken and H.D. Smith

wholesale drug company are scheduled to testify at the hearing next month. The Energy and Commerce Committee has spent the past year investigating the sale of pills in West Virginia by wholesale drug distributors, which are required by law to monitor and report suspicious opioid orders to the Drug Enforcement Administration (DEA). If orders and sales are not correctly reported for oversight, countless doses of potent drugs can be diverted to a booming illegal market and ultimately to drug abusers — many of whom became hopelessly addicted to the powerful painkillers. Committee members aggressively

questioned Robert W. Patterson, the acting head of the DEA, last month, asking how so many pills flowed freely and why, they said, the agency wasn’t forthcoming with information about how it handled opioids. The panel has sent letters to all of the distributors asking for information about steps they took to keep drugs off the black market and to report suspicious orders of pills. “This investigation is taking a hard look at troubling issues behind the surge in opioid deaths in America,” Walden said. “We expect to get answers next month from these officials about the companies they represent.”….Read More

Medicare Rights Center Helps Inform Changes to D-SNPs The recently-passed Bipartisan Budget Act of 2018 (BBA of 2018) makes a number of changes to Medicare, including permanently authorizing Dual Special Needs plans (D-SNPs), which are Medicare Advantage (MA) plans for people who are dually eligible for Medicare and Medicaid. To help inform implementation of these changes, earlier this month the Centers for Medicare & Medicaid Services (CMS) issued a request for stakeholder input on (1) The design of an integrated Medicare-Medicaid appeals approach for D-SNPs; and (2) The establishment of minimum state contract requirements for D-SNPs. The Medicare Rights Center’s comments, submitted today, are informed by our experience assisting Medicare beneficiaries, their family members, and health care professionals in general, and by our work with dually eligible New Yorkers and the programs that serve them in particular—including New York

State Medicare-Medicaid Fully Integrated Duals Advantage (FIDA) Plans and D-SNPs. Currently, nearly one-third of the over 700,000 full dual eligible New Yorkers are enrolled in some type of managed care product. However, most of these plans do not fully coordinate and integrate Medicare and Medicaid services. Through our helpline and casework, we know that many dually eligible New Yorkers experience fragmented care, often struggle to navigate their multiple plans or sources of coverage, and face challenges in trying to obtain needed services. Without access to care and effective coordination, beneficiaries may experience otherwise avoidable hospitalizations, duplication of services, and poorer health outcomes overall. Often, it is only when there is a problem in access or payment that the fractured nature of their coverage becomes apparent. Therefore, integration of the appeals and grievance

systems—where patients and providers turn when there is an issue—is of utmost importance. In developing a truly unified process, we recommend that CMS:  Take into account the “administrative” burden of directing and organizing the appeal that largely falls on beneficiary shoulders, in part by retaining the more protective rule when applicable rules conflict;  Consider the ways in which different appeals rules currently exist withinMedicare, in addition to the differences between Medicare and Medicaid;  Prohibit harmful plan marketing practices;  Include assisting and redirecting any appeal or grievance received among a D -SNP’s case management obligations; and  Ensure there is aid-to-continue or aid paid pending review for all claims. As CMS seeks to develop new

requirements for integration, we encourage the agency to:  Assign a care manager or point person at the D-SNP who can assist with coordinating care by locating in-network providers, helping with appeals and troubleshooting, and smoothing interactions between programs;  Require robust and meaningful care management that prioritizes integrated, comprehensive, personcentered decision making;  Allow comprehensive data sharing, including making Medicare and Medicaid claim information accessible to the plan, the care manager, and the beneficiary; and  Ensure oversight by both CMS and the state. This oversight should be transparent and accessible to beneficiaries, advocates, and researchers.

Rhode Island Alliance for Retired Americans, Inc. • 94 Cleveland Street • North Providence, RI • 02904-3525 • 401-480-8381 •

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RI ARA April 22, 2018 E-Newsletter


RI ARA April 22, 2018 E-Newsletter

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