'Lock-In' programs can deter prescription drug fraud

Limiting drug-abusing patients to one doctor, one pharmacy and one emergency room to dispense opioids and other high-risk drugs is a possible solution to prescription drug fraud and abuse, according to a new report by Devon M. Herrick, health economist and senior fellow at the National Center for Policy Analysis.

"Medicare has a drug problem," Herrick wrote. "When Congress passed the Medicare Part D drug program, it inadvertently created a license to steal."

Beneficiaries with multiple painkiller prescriptions or questionable drug seeking behavior can be "locked in," or sharply restricted in the providers they can see to obtain benefit payment for particular drugs. This strategy may generate cost savings and reduce narcotic drug abuse, RxTimes reported.

Forty-six state Medicaid programs have implemented Lock-In plans successfully, the article noted. And last August, U.S. Rep. Kevin Brady (R-Texas) circulated a draft bill--the Protecting Integrity in Medicare Act of 2014--to give Medicare drug plans a green light to implement Lock-In programs.

Large quantities of drugs paid for by the government wind up in the black market where their value exceeds their pharmacy cost. Drug diversion costs health insurers nearly $75 billion annually, with about two-thirds of those dollars siphoned from public programs, Herrick noted.

Moreover, for every dollar in drug costs insurance programs lose to fraud, an additional $41 is squandered on unnecessary doctors' office visits, redundant medical tests and unnecessary emergency room visits by pill seekers, Herrick noted.

Compounding the problem, overworked doctors may not spot signs of addiction and may not know that patients who occasionally renew an oxycodone prescription may have seen many other providers for the same purpose.

Moreover, drug claims filed require only a limited amount of supporting documentation, Herrick emphasized. "Consequently, fraudulent claims are easy to disguise and submit for payment, as they are hard to detect amidst billions of legitimate claims," Herrick wrote.

For more:
- read the NCPA study abstract and report (.pdf)
- here's Herrick's editorial in Investors.com
- see the RxTimes article