The Centers for Medicare & Medicaid Services has been lax in overseeing unsafe prescribing patterns for patients on Medicaid Part D, and has done little to thwart questionable prescribing practices, according to an analysis by ProPublica, an independent newsroom that performs investigative journalism in the public interest.
It analyzed four years of Medicare prescription records--2007 through 2010--obtained under the Freedom of Information Act and co-published results with the Washington Post. The analysis makes public the prescribing practices of identified providers, and a new tool, called Prescriber Checkup, allows the public to search for providers by name.
It found a widespread pattern of prescribing of drugs that are potentially harmful, disorienting or addictive for older Americans, determining that little has been done in the way of prevention.
The data show that 1.1 billion claims were filed in 2010, with 70 providers responsible for more than 50,000 prescriptions and refills each--about 137 a day.
The U.S. Food and Drug Administration has warned against prescribing antipsychotic medications for dementia patients, citing increased risk of death. Yet in 2010, nearly 340 providers wrote more than 1,000 antipsychotic prescriptions each for patients ages 65 and older.
The analysis also found that providers routinely prescribe drugs that have been pulled from foreign markets for safety reasons.
CMS officials say that oversight of doctors' prescribing habits should fall to payers, since the drug benefit is administered through private insurers--not CMS. The program's philosophy has been to defer to physician judgment in prescribing, the Post reports.
"CMS's payments don't go to physicians, don't go to pharmacies," Jonathan Blum, the agency's director of Medicare, told the Post. "They go to plans, which is how our oversight framework has been established."
ProPublica recommends changes, including periodic scrutiny of the data for those who frequently prescribe potentially harmful drugs; requiring private insurers in Part D to report suspicious activity; sharing prescribing data with state medical boards; and seeking Congressional authority to bar those who have been indicted or convicted in connection with Part D prescribing habits.
Investigations by the Los Angeles Times have been prodding California lawmakers into requiring that a statewide prescription database be used to root out physicians who prescribe drugs recklessly. The state Attorney General's office has said that budget cuts have left it without staff to investigate even if questionable practices are brought to light.
Forty-nine states have authorized prescription drug-monitoring programs, but many fail to take action with the data, according to a report published last fall by Brandeis University's Heller School for Social Policy and Management. State medical boards also have been criticized for doing too little to protect patients from dangerous doctors.
Meanwhile, the U.S. Department of Health & Human Services' Health Resources and Services Administration recently announced plans to consolidate two databanks that track questionable physician practices.
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