170,000 Medicare Part D patients cost the program up to $148 million by taking prescriptions for controlled substances to multiple doctors, who usually filled them without realizing the patients had already received the drugs elsewhere, according to a report from the Government Accountability Office (GAO).
The Forensic Audits and Special Investigations unit of GAO reported that, in 2008, patients “received prescriptions from five or more medical practitioners” for all 12 classes of “frequently abused controlled substances and 2 classes of frequently abused non-controlled substances.” GAO estimates that 1.8 percent of Medicare Part D beneficiaries abused the program in this manner.
The report noted that 71 percent of the patients who went “doctor shopping” to have their prescriptions repeatedly filled “were eligible for Medicare Part D benefits based on a disability.” That seems to raise the likelihood that many patients began using these drugs on a legitimate basis and then developed an addiction.
But Sen. Scott Brown, R-Mass., noted the incentive for “illicit prescription drug dealing” during a Senate subcommittee hearing yesterday on the issue. “One Medicare recipient, as you know, visited 58 different doctors to obtain 3,655 Oxycodone pills.” Brown said. “[That’s] equivalent to a 1,679 day supply and these prescriptions equate to a street value of almost $300,000 . . . it takes a very high human toll.” Brown called the “breakdown” in management of the Medicare Part D program “unconscionable.”
The GAO report highlighted, among others, a Medicare Part D beneficiary who “received 1,397 fentanyl patches and pills (a 1,758-day supply) from 21 different prescribers,” as well as another patient who received 4,574 hydrocodone pills from 25 different prescribers in 2008.
Gregory Kutz, from the GAO, recommended that Center for Medicare and Medicaid Services (CMS) develop a restricted recipient program that might prevent “abusers [who] generally face no criminal consequences and are not removed from Part D” from using more than one doctor or pharmacy to get their prescriptions.
Jonathan Blum, a representative of CMS, said that the program had hitherto focused on avoiding “underutilization” of drugs by beneficiaries who need the prescriptions, but the program’s analysis would “include proactively focusing on drug overutilization.” Blum also said that, in the case of anti-psychotic medications, “there is evidence that the financial relationships between long-term care pharmacies and drug manufacturers can lead to this overutilization.”
You can see the full GAO report below.
