State Acts To Curb Excessive Pill Use By Medicaid Patients

(AP) – State officials believe they’ve found a way to rein in taxpayer support of painkiller addictions and get some Medicaid patients into drug treatment. They’re tracking prescriptions of narcotics, antidepressants and other medications, and following up when the amounts seem excessive. “There are clients out there who are getting medications and selling them on the street. There are clients out there who have substance abuse issues who are seeking this out for abuse and misuse,” said Dr. Jeffery Thompson, chief medical officer of Medicaid in Washington, a health program for the poor financed by state and federal governments. The enforcement program is focused on patient safety, not fraud, he said. Hospice and cancer patients are excluded from the crackdown. Earlier this year, 2,600 Washington state doctors caring for about 1,000 Medicaid clients were advised that their patients may have been inappropriately taking multiple antidepressants or other drugs. Next week, the state plans to send letters to about 320 patients who were given 10 or more narcotic prescriptions in a single month in 2004, or seven or more prescriptions for six months last year, Thompson said. And starting July 12, the state Department of Social and Health Services won’t pay for more prescriptions for those clients unless their providers confirm they’ve reviewed patients’ medication and hospitalization records. A high number of prescriptions often indicates “something wrong is going on,” he said, noting that he gets one or two reports a month of Medicaid clients selling their prescription medications. And excessive pill use can put patients at risk. In 2000, 43 percent of U.S. emergency-room overdose cases, nearly half a million patients, involved prescription drugs, according to the Substance Abuse and Mental Health Services Administration, an agency of the U.S. Department of Health and Human Services. In many cases, doctors don’t know what drugs have been prescribed for their patients by other doctors, specialists and emergency rooms. “A lot of times, these people can slip through the cracks,” said Rod Shafer, chief executive officer of the Washington State Pharmacy Association. The new initiative is intended to “improve care or stop destructive behavior.” “Whether it’s misuse or abuse, or whether it was a refill that was just forgotten about, we don’t care,” Thompson said. “What we care about is making sure the client is getting the best medical care, and we want to provide (doctors) enough information to make that judgment.” During off hours, pharmacists will be allowed to dispense emergency supplies, he said. DSHS also sent doctors information on how to restrict patients to a single doctor and pharmacy if necessary. The agency will send quarterly updates of clients’ medications to doctors, pharmacies and emergency rooms. And the agency will send those clients’ names to its drug-treatment division, Thompson said. “If we save money, great,” he said. “If we don’t save money but we improve care, that’s also great.” The idea to increase scrutiny of anti-depressant use evolved from a work group of health professionals, patient advocates and others convened by Thompson to prepare for new restrictions on Medicaid prescriptions. Under a recent change in Washington law, doctors must get state approval before prescribing medications that are not listed on a state “preferred drug list.” The restrictions on antidepressants begin July 1. Advocates for the mentally ill in the work group said they support the oversight, but are concerned about the restrictions. “I still have the same concerns over safety and the restrictions of (psychotropic) medications,” said Peter Lukevich, director of Partners in Crisis, a group that advocates for the mentally ill in the criminal justice system. But he said the new oversight, “we are taking some very positive steps,” he said. This summer, Thompson plans to conduct a similar review of the use of anti-psychotic drugs. DSHS spokesman Jim Stevenson said the department routinely communicates with health providers about Medicaid clients and has established safeguards for protecting patient confidentiality. Thompson said, he’d like to provide oversight for all Medicaid prescriptions. Better communication would lead to better care, he said. “There is no health care system,” he said. “There is a confederation of cottage industries.”