FACTS Act of 2017

Furthering Access to Coordinated Treatment for Seniors Act of 2017 or the FACTS Act of 2017

This bill amends title XVIII (Medicare) of the Social Security Act to allow Medicare prescription drug plan (PDP) sponsors to access certain Medicare claims data. Specifically, the Centers for Medicare & Medicaid Services (CMS) must establish a process for PDP sponsors to request, beginning in plan year 2020, standardized extracts of claims data for Medicare hospital and medical services.

PDP sponsors may use such data: (1) to optimize therapeutic outcomes through improved medication use, (2) to improve care coordination so as to prevent adverse health outcomes, or (3) for any other purpose determined appropriate by the CMS. PDP sponsors may not, however, use such data: (1) to inform coverage determinations; (2) to conduct retroactive reviews of medically accepted indications determinations; (3) to direct enrollment changes; (4) to inform marketing of benefits; or (5) for certain other purposes affecting the security of personal health information, as determined by the CMS.