Medicare Part D is paying for antipsychotic drugs prescribed to nursing home residents for illegitimate reasons — including nursing home ‘staff convenience’ — which endangers patients and costs taxpayers hundreds of millions of dollars, according to congressional testimony today.
“[Two inspector general reports] indicate that Medicare is paying for drugs that it should not and Part D prescription drug plans are not able to adequately prevent inappropriate payments for drugs, including antipsychotics, for uses that do not meet coverage requirements,” said Daniel Levinson, Department of Health and Human Services Inspector General, during testimony before the Senate Special Committee on Aging.
“These findings indicate that Medicare is paying for drugs that it should not and Part D prescription drug plans are not able to adequately prevent inappropriate payments for drugs, including antipsychotics, for uses that do not meet coverage requirements,” he added. Over a six month period in 2007, Medicare made $116 million in inappropriate payments.
The prescriptions funded under the entitlement program can be fatal to nursing home residents. “[The Food and Drug Administration] has imposed a strong safety warning on atypical antipsychotics, emphasizing an increased risk of death when used by elderly patients,” Levinson said, adding later that “eighty-eight percent of atypical antipsychotic drugs claims were for residents with dementia.”
Levinson also noted that “staff convenience,” rather than patient need, can sometimes motivate these prescriptions, and he suggested that some “nursing homes are not adequately ensuring residents’ health and safety.”
“For example, in one case, a workup of an agitated patient would have detected a urinary tract infection,” Levinson explained. “Instead of properly diagnosing the urinary tract infection and treating it with antibiotics, the patient was given antipsychotic drugs to control the agitation.”
“Over the next 18 years, 10,000 Americans will become newly eligible for Medicare each day,” he concluded. “[I]t is imperative to address the overuse and misuse of antipsychotic drugs among nursing home patients.”
