CEO Blog/3.7.18


Susan A. Cantrell, RPh, CAE



AMCP Legislative Days Focuses on Passage of PIE Act, Efforts to Reduce Fraud, Waste and Abuse in Medicare Part D 



March 7, 2018

One of AMCP’s key strategic pillars is to advocate for legislation that will help advance the profession of managed care pharmacy. This function is on full display this week during our Annual Legislative Days event. I am proud to join nearly 20 of AMCP’s volunteer leaders and staff in a trek up Capitol Hill to meet with more than 50 House and Senate offices on two crucial issues: 

Passage of the Pharmaceutical Information Exchange (PIE) Act of 2018 (H.R. 2026).
Initiatives to reduce fraud, waste and abuse under the Medicare Part D program.
The first issue is one you’ve heard me discuss many times. In a nutshell, the PIE Act will allow biopharmaceutical manufacturers to proactively share truthful and non-misleading clinical and economic information about medications in the pipeline with population health decision makers at least 12-18 months prior to FDA approval, during the forecasting and rate setting process. AMCP has been leading advocacy on H.R. 2026 as it will allow decision makers to expedite coverage decisions as soon as new medications hit the market. 

The PIE Act is in a crucial phase. It recently passed the House Energy & Commerce Committee’s Subcommittee on Health, and is now before the full E&C Committee. A vote is expected very soon. During our visits this week we sought bipartisan House support for the bill, as well as a Senate champion.

The second top issue at Legislative Days aims to address ongoing concerns over continued fraud in the Medicare Part D program. In 2016, the federal government spent $1 trillion on Medicare Part D, but CMS estimated that $2.39 billion of that total was for improper prescription payments. CMS has testified that they cannot extrapolate how many claims are actually fraud, waste or abuse, but in 2017, the DOJ and HHS announced charges for more than 400 individuals who claimed more than $1.3 billion in fraudulent billings/payments.

The current Congress has not yet introduced specific legislation to address fraud, waste and abuse in Part D, but has expressed great interest in addressing the problem. AMCP supports reducing the current practice of “pay and chase,” to recover fraudulent payments. Part D Prescription Drug Plan (PDP) sponsors can and should play an important role in fighting fraud in the Medicare Part D Program. Greater involvement by PDP sponsors will reduce the incidence of fraud and result in substantial savings for beneficiaries and taxpayers.

AMCP works continuously on behalf of our members, including on these issues and others. We are cementing our reputation in Washington as the “go-to” organization for population health management and design of medication benefits. Stay tuned for more details on Legislative Days 2018, and visit