Medicare prescription drug abuse a problem: GAO
Prescription drug abuse by elderly and disabled beneficiaries of Medicare cost the U.S. program nearly $150 million in 2008, highlighting an area where the government can seek to save health costs.
According to a government report released on Tuesday, some of these patients went to at least five doctors to get multiple prescriptions of drugs that are often abused.
In all, 170,000 people enrolled in the Medicare Part D prescription drug program went “doctor shopping” for drugs such as oxycodone and hydrocodone, powerful painkillers that can lead to addiction, according to the report by the Government Accountability Office (GAO).
Those 170,000 who possibly abused the system were 1.8 percent of the patients who had prescriptions for these commonly abused drugs.
The study began in 2010, using data from 2008, the latest year then available. Medicare enrolled about 43 million people in 2008.
In one example, one individual received prescriptions from 87 different doctors during that year. Senator Scott Brown, a Republican from Massachusetts, dubbed it “taxpayer-funded drug dealing” at a hearing about the issue on Tuesday.
Brown said oxycodone could sell for over $5,000 in some areas of the country.
“Medicare Part D beneficiaries are abusing powerful drugs to fill their own addictions or to sell them on the street,” said Senator Tom Carper, a Democrat and chairman of a subcommittee on federal financial management. “The controls ... put in place haven’t done the trick.”
Persons over the age of 65 make up only 13 percent of the population, yet they account for about one-third of all medications prescribed in the United States. As the Baby Boomer generation ages over the next 20 years, the potential for misuse of prescription drugs increases.
Older patients are more likely to be prescribed long-term and multiple prescriptions, which can lead to unintentional misuse. It can be very challenging for even the most aware person to keep track of up to 30 different pills taken in one day – all at different times and in different doses.
The elderly are also at risk for prescription drug abuse – taking medications that are not medically necessary or using medications for conditions they are not originally prescribed for. Elderly individuals may be reluctant to report depressive symptoms to their doctors, and instead misuse prescription and over-the-counter drugs to self-medicate.
There are many reasons why misuse of prescription drugs can be more dangerous among the elderly than in any other demographic. Older people are more likely to take multiple prescriptions for increasing health concerns. They also use over-the-counter medicines and dietary supplements, increasing the risk of negative drug interactions.
The Centers for Medicare and Medicaid Services (CMS) notified doctors about patients who could be abusing prescription drugs. Jonathan Blum, director of CMS’s Center for Medicare, said his agency’s fraud division was receiving a growing number of complaints about the issue.
Fighting Medicare fraud has gained renewed urgency in recent months as a committee of Republicans and Democrats seeks ways to cut the nation’s ballooning budget deficit ahead of a November deadline.
“Everyone always has an angle to screw the government out of taxpayer money,” Brown said. “We’re just doing things so inefficiently, it’s mind-boggling.”
The GAO and others called on CMS to take more stringent steps to prevent Medicare fraud, such as limiting patients to one doctor and one pharmacy to better monitor abuse.
However, Blum said some patients with cancer, multiple-sclerosis or other diseases with complex treatments, or those without primary care physicians, may need to see several doctors.
“Some beneficiaries are bouncing around from emergency room to emergency room,” Blum said at the hearing. “We have a very uncoordinated healthcare system today that we are working hard to reform.”
“There is a balance between stopping behavior that is clearly fraudulent and illegal, and ensuring that beneficiaries have access to medication,” he said.
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WASHINGTON