Among many measures in the Comprehensive Addiction and Recovery Act (CARA) of 2016, signed into law last week by President Obama, was a Part D “lock-in” program intended to prevent people with Medicare from misusing certain prescription drugs. The Medicare Rights Center played a pivotal role in shaping the program’s consumer safeguards along with its national partners.
Earlier this year, Medicare Rights encouraged members of Congress to ensure that any Part D “lock-in” program was carefully designed, so as to not to block access to opioids for those who truly need them. Experiences on the Medicare Rights national helpline helping people with Medicare navigate prescription drug denials and appeals shaped the recommendations, including the need for clear and detailed notices, escalated appeal options, and clear processes to facilitate patient input on the program design.
CARA allows the federal government to create a “lock-in” program that limits beneficiaries who are at-risk for misusing specific medications to one prescriber and one pharmacy to access those prescription drugs. CARA establishes clear notice requirements, preserves beneficiary choice of prescriber and pharmacy, advances options to improve appeals processes, and sets up a formal process to involve beneficiaries and their advocates as the program is implemented.
Medicare Rights deeply appreciates the bipartisan collaboration that led to Medicare “lock-in” legislation that incorporates many essential consumer protections and looks forward to working closely with the Centers for Medicare & Medicaid Services to ensure the program is adequately implemented and monitored.