Read my speech on fighting opioid abuse

SEN. PAT TOOMEY:

Mr. President, I rise on the same topic that the Senator from Indiana was addressing very eloquently and the absolutely heart-wrenching story that he told of his constituent and the families. This is a story we hear all across America. I hear it all across Pennsylvania. It’s day in and day out. This is an enormous problem. It’s devastating families and communities in our entire states. I share the view of the Senator from Indiana that this legislation is very, very important. It takes a number of steps that are very constructive. I congratulate Senator Whitehouse and Senator Portman for a very good piece of legislation that is going to help–it’s going to help save lives. It’s going to help save families and comunities.

I’ve got an amendment that I’m going to address that’s going to take another step to save lives and I hope my colleagues will overwhelmingly support this because it’s an epidemic the likes of which I don’t know if we’ve seen in a very, very long time. Last October I convened a field hearing of the Senate Finance Subcommittee on Health Care to learn more about this very epidemic of opioid addiction and heroin addiction and the overdoses that are resulting. We did it out in Pittsburgh and Senator Casey joined me. And we reserved a very large auditorium and we invited some of the leading local experts and doctors who are dealing with people who are suffering from addiction, law enforcement folks, and recovering addicts. And we had a standing-room-only crowd in that room. Such was the intensity of this issue and the concern about it because we all know people who are affected by this terrible scourge. A couple of things that I learned in that hearing, two that are important to me is we’ve got to figure out how we can reduce some of the overprescribing of these narcotics, these prescription opioids upon which people then become addicted, and we’ve got to find ways to reduce the diversion from prescriptions that are obtained through the conventional process to the black markets, the streets, the places where it feeds the addiction.

I think that one of the overlooked elements of this problem has been the opioid epidemic that’s affecting older folks, aging baby boomers, senior citizens who become addicted to opioids for a variety of reasons. The headlines have screamed about this. USA Today said, and I quote, “Many seniors hooked on prescription drugs.” That was their headline. The Wall Street Journal headline recently: “Aging baby boomers bring drug habits into middle age.” From a TV news channel: “Senior citizens getting hooked on painkillers.” This is a growing problem and it doesn’t know any demographic limits. It affects senior citizens as well as young people. In fact, in 2013, to give a sense of one of the perhaps contributing elements to this, there were 55 million opioid prescriptions written in America for Americans over the age of 65. It’s a stunning number. It’s a 20% increase in just five years. We have not had a comparable increase in the number of senior citizens. It’s a huge increase in the number of prescriptions per person. And this is probably related to the fact that opioid addicted seniors have itself tripled in the last decade. So one of the problems has been identified by the Government Accountability Office.

They estimate that in one year alone, 170,000 Medicare enrollees, 170,000, engaged in doctor shopping.

They estimate that in one year alone, 170,000 Medicare enrollees, 170,000, engaged in doctor shopping. That’s the process by which beneficiaries go to multiple doctors to get multiple prescriptions for the same or similar powerful narcotics. Then they go to multiple pharmacies to get them all filled and they end up with these commercial quantities of prescription drugs vastly beyond anything that any individual cold need. One, one beneficiary that G.A.O. discovered had visited 89 different doctors in one year just to get prescription painkillers. 89 doctors in one year! That’s almost two a week. Another beneficiary received prescriptions for 1,289 hydrocodone pills. That’s like almost a two-year supply. It makes no sense.

So I could go on and on with cases in which fraud is being committed for the purpose of obtaining these prescriptions, which are then sold on the black market. But there’s also a subset of Medicare beneficiaries who are innocently getting duplicate opioid prescriptions because they are being treated by different doctors for different maladies. They have multiple illnesses. They get multiple prescriptions because in many cases there’s nobody providing adequate oversight and coordination for their care. So we have both people who are intentionally and fraudulently getting multiple prescriptions and then we have people who are innocently getting it. So there’s a way we can deal with this, Mr. President, a way we can deal with this inappropriate prescription and diversion into the black market. And the Administration has asked us to do this. This Administration, the Obama Administration, has asked Congress to give them in Medicare the power to limit certain beneficiaries who are engaged in doctor shopping, exactly as people already can do so within Medicaid and private health care providers.

So the simple idea is to give Medicare the power when it identifies a beneficiary that is engaged in doctor shopping, getting multiple duplicative prescriptions either intentionally or unintentionally. Allow Medicare to lock that patient in to one prescriber and one pharmacy. That way you don’t have this problem. And that’s what the Administration has asked us to do, so I have introduced a bill that does exactly that. It’s called the Stopping Medication Abuse and Protecting Seniors Act. Senator Brown from Ohio is the lead Democrat on this Bill. I want to thank Senators Portman and Kaine also for their work on this, and this is the amendment we are offering to this bill, to give Medicare the very same tool that Medicaid has, the tool that the Administration is asking for, the tool that all experts say will make sense. As I said, Medicaid and commercial users already do this.

What we are doing is applying a proven technique that has overprescribing and diversion, applying that to Medicare where it does not exist today.

We’re not inventing something new. What we are doing is applying a proven technique that has overprescribing and diversion, applying that to Medicare where it does not exist today. No one who legitimately needs a prescription for opioids will be denied that. That would be completely unreasonable and inappropriate. In fact, we exempt seniors in nursing homes where the nursing home can provide the monitoring, seniors who are in hospice or cancer patients who might need unusually large quantities, they are exempted. In fact, this legislation would only lock in a small fraction of 1% of Medicare enrollees, but that is the fraction that is engaging in this very dangerous behavior. So, first of all, I’m grateful for the very broad bipartisan support that we have. As a result, if we get this passed today, which i certainly hope we will, we will help opioid-addicted seniors find treatment because they will be notified when they come up on this list when it is discovered that they are going to multiple doctors and multiple pharmacies.

We’ll stop the diversion of these powerful narcotics. It will save taxpayer money because taxpayers reimburse for all of these prescriptions even those that are fraudulent, and maybe most importantly it’s going to reduce the availability of these opioids. We have 25 republican and democratic cosponsors on the bill. We have the support of the National Governors’ Association. Nearly identical language was already passed in the House. It was embedded in the 21st century Cures Legislation, where it passed overwhelmingly. The president’s budget has asked for this very mechanism repeatedly.

The C.M.S. Acting Administrator was before our committee and Administrator Slavitt said this legislation makes “every bit of sense in the world.” That’s a quote. The C.D.C. Director is for it, the White House Drug Czar is for it, the Pew Charitable Trust testified on behalf of our legislation, and so do Physicians for Responsible Opioid Prescribing, not to mention many law enforcement groups and senior groups like the Medicare Rights Center. This is a tool, Mr. President, that is just overdue. We’ve got this tool in private health care insurance coverage, We have got this tool in Medicaid. We just need to have this tool in Medicare. I really want to single out for a special thanks my co-author Sherrod Brown.

Senator Brown and his staff worked very hard, did a tremendous job. They provided in fact very valuable feedback to make sure that all the stakeholders were going to be treated fairly and specifically, that beneficiary rights would be properly respected, and that’s very important and a very constructive contribution that Senator Brown made to this legislation. He also helped to secure many endorsements from outside groups. My fellow Pennsylvanian, Senator Casey. again, very, very helpful, passionate about this issue. He has seen firsthand the damage that’s being done across Pennsylvania from opioid abuse, and he is a cosponsor of the legislation. We had a very successful hearing in the Finance Committee and I want to thank Senator Hatch for having this very topic of how we can limit the diversion through Medicare of these very dangerous narcotics, and I thought that that was a very constructive hearing.

Also Senator Kaine through his work on the Senate Aging Committee has been very active and extremely helpful on this issue. So again, Mr. President, this is an amendment that has broad bipartisan support, it’s been vetted by the stakeholders, it’s been vetted by and requested by the Administration, it’s endorsed by numerous health care and law enforcement groups, and the reason it has such broad support is because it will save lives, it will protect seniors from opioid overprescriptions, it will stop fraud and it will dramatically reduce pill diversion. So to vote no on this would be to allow the continued flooding of very dangerous prescription opioids onto the black market, and I can’t think of any reason we would want to do that. So, Mr. President, I urge my colleagues to support the bipartisan Toomey-Brown-Portman-Kaine amendment. Let’s get this passed and then pass this underlying bill, which is very constructive as well.