A recently released report form the Government Accountability Office (GAO) found more than 170,000 instances of so-called 'doctor shopping' of 14 commonly abused prescription medications by Medicare Part D beneficiaries.
A Senate hearing is set to take place today to examine why Medicare has been slow to respond to the evidence of doctor shopping in the program. In all, the 170,000 reported cases of doctor shopping represent 1.8 percent of all Medicare Part D beneficiaries who received prescriptions for one or more of the 14 drugs. Those patients in the 170,000 instances identified by GAO had received prescriptions from five or more doctors, with most of the prescriptions written for the highly abused drugs oxycodone and hydrocodone.
In one instance, a beneficiary from Georgia received prescriptions in 2008 for 3,655 oxycodone pills – a 1,679-day supply – from 58 different prescribers. Two pharmacies eventually refused to fill the prescriptions on suspicion of forgery.
[See also: Pharmacists charged in $3M Medicare fraud scheme]
"To improve efforts to address doctor shopping by beneficiaries of highly abused prescription drugs, the Administrator of CMS should review our findings, evaluate the existing drug utilization review (DUR) program, and consider additional steps such as a restricted recipient program for Medicare Part D that would limit these beneficiaries to one prescriber, one pharmacy, or both for receiving prescriptions," the report by GAO Director of Forensic Audits and Investigative Service Gergory D. Kutz recommended.
GAO also recommended that CMS take similar steps to restrict access to frequently abused drugs, and that it should specifically target the drugs oxycodone and hydrocodone for a pilot program to test whether this would cut down on the abuse. It also suggested CMS develop a method whereby Medicare Part D insurers could share information to ferret out beneficiaries who frequently switch plans – something that is not allowed under current law.
But CMS officials told GAO investigators that they may not have enough power under federal law to effectively restrict beneficiaries' access to drugs in the program, even highly abused drugs like oxycodone and hydrocodone. CMS is also concerned that any restricted recipient program for these drugs may provide barriers to care for the 98 percent of Medicare Part D beneficiaries who legitimately need the medications.
In a written response to the GAO report, CMS indicated that "high utilization of pain medications is not necessarily an indication of abuse, but could be an indication of poorly coordinated care in the treatment of pain symptoms."
Still, CMS acknowledged that prescriptions for opiates in the Part D program are on the rise. Deputy Administrator of CMS, Jonathan Blum told the New York Times that the Part D plans provided more than 57,000 prescriptions for opiates last year, up sharply from 2007 when the plans provided benefits for 46,000 opiate prescriptions.