The Centers for Disease Control and Prevention (CDC) rightly calls prescription drug abuse a national epidemic, costing tens of thousands of lives and tens of billions of dollars a year. Simply put: the status quo is unacceptable and we can do better.

This week I spoke on Capitol Hill to urge action on some common sense solutions offered by Ways and Means Subcommittee on Health Chairman Kevin BradyKevin Patrick BradyRepublicans can't handle the truth about taxes Democrats see political winner in tax fight The Hill's Morning Report - Biden may find zero GOP support for jobs plan MORE (R-Texas) and Reps. Gus Bilirakis (R-Fla.), Ben Ray Lujan (D-N.M.) and Frank Pallone (D-N.J.). Their proposals get to the heart of the problem: stopping inappropriate prescriptions from crossing the pharmacy counter. 

Two basic reforms are needed to get this done.


First, we need a “Safe Pharmacy,” or “Lock-In” policy in Medicare in which the small segment of patients who are at risk of abusing opioids would choose – along with their health plan – a single, convenient pharmacy to fill their prescriptions for controlled substances. This is easy, because most patients would simply choose from among the pharmacies they already use.

The goal of such an approach is to prevent “Drugstore Shopping,” the practice of filling prescriptions for controlled substances – whether using copies of the same prescription over and over or separate ones procured from different prescribers – at multiple drugstores to avoid detection. Local, community pharmacists are often targeted because they can’t communicate with each other and don’t share centralized claims systems like chain drug stores.

A recent report by the Department of Health and Human Services, Office of the Inspector General (HHS-OIG) called for a pharmacy “Lock-In” program in Medicare Part D to help decrease prescription drug abuse. Currently, 46 state Medicaid agencies operate these programs, and 49 states have enacted prescription drug monitoring legislation.

HHS, CDC, the Centers for Medicare & Medicaid Services, the Government Accountability Office and the Office of National Drug Control Policy have all called for a “Lock-In” program, in Medicare, in one form or another.  

Second, we must close the loophole in Medicare that prevents Part D plans from suspending payments to pharmacies suspected of fraud or diversion. Another OIG report found that 2,600 pharmacies had questionable billing practices. All providers in Medicare except druggists are subject to this routine accountability. It works well for hospitals and doctors and it would work for pharmacies, too.

Protecting patients from harm by curbing prescription drug fraud, waste and abuse is important to all Americans. Fortunately, it’s also the kind of reform Democrats and Republicans can work together on. The time to act is now.

Merritt is president and CEO of the the Pharmaceutical Care Management Association.