Medicare beneficiaries, as many as 170,000 of them, may have been doctor shopping in order to obtain multiple prescriptions of muscle relaxer and non-narcotic painkiller drugs, according to a recent Government Accountability Office audit of the Medicare Part D prescription drugs plan.
Among the commonly used medications sought by the Medicare beneficiaries in question were popular drugs like oxycodone, Adderall (a form of amphetamine and dextroamphetamine), Valium (a brand of diazepam), Xanax (a brand of alprazolam), carisoprodol (sold under the brand Soma), and the non-narcotic painkiller drugs, and brands of tramadol, Ultram and Ultracet .
The audit determined that 170,000 beneficiaries of Medicare had received five or more prescriptions from different doctors for these and other popular medications, all at a cost of approximately $148 million to the Medicare Part D program.
Though Medicare is generally thought of as a program to benefit senior citizens, the overwhelming majority of the suspected doctor shoppers are not on Medicare due to their age. Nearly three-quarters, about 71%, had Part D coverage due to disability. Even more, 72%, benefited from the Medicare Low-Income Cost-Sharing subsidy.
The most sought-after medications were hydrocodone and oxycodone, two of the most prescribed and most abused painkiller drugs in the United States. The findings of the GAO audit have raised heightened concern among government officials and legislators that Medicare benefits are being used to disguise and subsidize addictions. One U.S. Senator, Scott Brown of Massachusetts, referred to the doctor-shopping as “taxpayer-funded drug dealing.”
The GAO audit involved a review of prescriptions filled by beneficiaries of Medicare Part D between May 2010 and October 2011 for a dozen controlled substances, including those listed above. The GAO focused its investigation on specific cases, determining that the doctors who wrote those prescriptions were unaware that their patients had been abusing the drugs, trying to sell them, or visiting other doctors to obtain more.
According to the investigation, one beneficiary received prescriptions for oxycodone from 58 separate doctors, filled at 45 separate pharmacies, totalling 3,655 pills. Another obtained a 994-day supply of hydrocodone from 25 different prescribers.
As a result of these findings, the GAO has recommended imposing limitations on identified doctor shoppers of a single doctor and a single pharmacy. Also recommended is turning over the names of known doctor shoppers to insurance companies that administer Medicare Part D plans.
CMS, the Centers for Medicare and Medicaid Services, has proposed an alternative rule requiring that Part D sponsors include a physician identifier on all prescriptions, allowing insurers to confirm that the prescription was written by an actual doctor. CMS has also proposed new guidelines for detecting and reporting misuse of controlled substances.