Extreme Opioid Use and Doctor Shopping Plague Medicare
The Inspector General of the U.S. Department of Health and Human Services recently released a report on painkiller abuse amongst medicare patients. The Inspector General found that heavy use and abuse of painkillers is very common in Medicare’s prescription drug program. For example, one medicare patient received 2,330 opioid pills in a single month. Below are more of the Inspector General’s findings:
- Of the one third of Medicare beneficiaries in Part D (or roughly 14.4 million people) who filled at least one prescription for an opioid in 2016, some 3.6 million received the painkillers for at least six months.
- There were wide geographic differences in prescribing patterns, consistent with data released last week by the Centers for Disease Control and Prevention. Alabama and Mississippi had the highest proportions of patients taking prescription painkillers — more than 45 percent each — while Hawaii and New York had the lowest — 22 percent or less.
- More than half a million beneficiaries received what the report defined as high doses of opioids for at least three months — meaning they got the equivalent of 12 tablets a day of Vicodin 10 mg. The figure does not include patients who have cancer or those who are in hospice care, for whom such high doses may be appropriate.
- Almost 70,000 beneficiaries received what the inspector general labeled as extreme amounts of the drugs — an average daily consumption for the year that was more than two and a half times the level the CDC recommends avoiding. Such large doses put patients at an increased risk of overdose death. Extreme prescribing could also indicate that a patient’s identity has been stolen, or that the patient is diverting medications for resale.
- Some 22,000 beneficiaries seem to be doctor shopping — obtaining large amounts of the drugs prescribed by four or more doctors and filled at four or more pharmacies. All states except for Missouri operate Prescription Drug Monitoring Program databases that allow doctors to check, before writing a prescription, whether their patient has already received the drug or similar drugs from other doctors.
- More than 400 doctors, nurse practitioners and physician assistants had questionable prescribing patterns for the beneficiaries most at risk, meaning those who took extreme doses of the drugs or showed signs of doctor shopping. One Missouri prescriber wrote an average of 31 opioid prescriptions for each of 112 patients on Medicare. And four doctors in the same Texas practice ordered opioids for more than 56 beneficiaries who seemed to be doctor shopping. “The patterns of these 401 prescribers are far outside the norm and warrant further scrutiny,” the inspector general said.
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