Senate Judiciary takes on Medicaid Rx rates

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Sunshine bill is back with sharper teeth
Sunshine bill is back with sharper teeth
Senator Chuck Grassley (R-IA) put 34 Medicaid programs on notice that they are not doing enough to rein in over-prescription of certain drugs and he wants to know why. He has issued a 12-point questionnaire that includes questions about how and if the states track their prescriptions and or provider prescription rates. They have until February 13 to reply, but the letter does not indicate whether there are consequences for not responding.

“Mental health drugs continue to be prescribed at astounding rates and pain management clinics are turning into a hotbed for black market painkillers. When these drugs are prescribed to Medicaid patients, it is the American people who pay the price for over-prescription, abuse, and fraud” he wrote.

The targeted drugs fall into three categories: anti-psychotics, anti-anxiety and pain-killing medications. Most of the cited programs had two to four over-prescribed medications. Some states, like Nevada, which was cited for eight drugs, and Illinois, which was cited for five, were outliers. The painkiller oxycontin and the anti-psychotic Abilify were among the most overprescribed among the 33 states and the District of Columbia.

Grassley says the prescription rates are astounding—and expensive. His letter to Illinois says doctors cost the state Medicaid program $2.9 million in prescriptions for Geodon, Xanax, Abilify, Zyprexa and Seroquel, and that high prescription rates cost Florida's Medicaid program over $4 million in 2009.

The senator's request is actually part two of an inquiry he kicked off in 2010, when he asked these same programs to identify their top 10 Medicaid prescribers of Abilify, Geodon, Seroquel, Zyprexa, Risperdal, Oxycontin, Roxicodone and Xanax. He said his inquiry, As the ranking member of the Senate Finance Committee, he said his inquiry was to ensure the $317 billion states spend on Medicaid annually were legitimate expenses, as opposed to being applied to fraudulent prescriptions.

Monday's letter  letter to California explained the appeal; the senator explained that addicts use the antipsychotic drug Zyprexa to enhance and lengthen an opioid's effects Two doctors wrote 2,300 scripts for the drug in 2009. Cost: $879,000.

Propublica reports that the 13,825 Abilify prescriptions by a single Ohio provider in 2009 equals 54 prescriptions per weekday and cost the state $6.7 million.

Grassley's letters acknowledge that there is room to misinterpret the data, but that he is still concerned about “the oversight and enforcement of Medicaid abuse in your state. While I am sensitive to concerns about the potential for misinterpretation of the data you provided, the numbers themselves are quite shocking.”

His inquiry is not necessarily welcome.

“To commence an inquisition into any given physician's choice of patient care is ill-considered. Doctors should not have their choices for patient care either dictated or influenced by a politician's hunt for headlines. Senator Grassley should be smart enough to understand the unintended consequences of such an ill-considered act,” Center for Medicine in the Public Interest founder Peter Pitts wrote in an email.


John Kamp, executive director for the Coalition for Healthcare Communication, agrees, and told MM&M in an email that the Senator is off course. “I'd prefer he would help patients get the scrips they need for critical care . .. Good prescribing habits coupled with patient adherence would do more for the public health than these nasty accusations that cast shadows over health care professionals," he wrote.
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