Report on Medicare Cites Prescription Drug Abuse

[Omaha Steve]

Source: NY Times

By ROBERT PEAR

WASHINGTON — Medicare is subsidizing drug abuse by thousands of beneficiaries who shop around for doctors and fill prescriptions for huge quantities of painkillers and other narcotics far exceeding what any patient could safely use, Congressional investigators say in a new report.

The investigators, from the Government Accountability Office, said Medicare officials had been slow to recognize and act on the evidence of abuse, which is to be presented at a Senate hearing on Tuesday.

“Our analysis found that about 170,000 Medicare beneficiaries received prescriptions from five or more medical practitioners” for 14 types of drugs that are frequently abused, said Gregory D. Kutz, director of forensic audits and special investigations at the accounting office.

The medications were obtained through Part D of Medicare, which provides coverage for prescription drugs. The drugs most commonly abused by Medicare beneficiaries included powerful prescription painkillers like oxycodones and hydrocodone products. Oxycodones include OxyContin and Percocet.

Read more: http://www.nytimes.com/2011/10/04/health/policy/04medicare.html?partner=EXCITE&ei=5043

[axollot]

1. The war on pain patients is horrific. There is no way I could see that

many docs. I live in Florida. I am disabled on medicare. This is propaganda. Why? Well they just got rid of the south florida clinics that were the main problem.

The rest of us REAL patients have been f'ing abused. BAD. The new data base went into effect on the 1st of Sept. Oh and there is no way they would fill more than ONE of the scripts over the past 8yrs on insurance. One 30day period and that is it. It'll come back 'refill too soon' but I do know pain meds are the drug war du jour.

Cheers
Sandy

[INdemo]

3. Agreed..I just don't see how a prescription can be filled twice

in less than a 30 day period..In fact pain meds sometimes if not always need a prior authorization..Meaning the prescribing Physicians office will usually have to provide a reason by fax before script is filled.

[kag]

5. I, too, am a pain patient...

but i have private insurance through my husband's job, and there is NO WAY I would be allowed to fill a prescription too early (more than 25 days apart).

However, one thing stood out for me in the OP. The amount of narcotics a patient can "safely" use varies according to your tolerance. Frankly the amount I take would kill a linebacker in the NFL who wasn't tolerant, but for me it barely touches the pain and I can even still drive safely. I know middle aged women who weigh less than 120 lbs who can take several hundred mgs of oxycodone every day.

[axollot]

11. Same here. I feel for you. Right now being put through hell

because I had to change doctors in July. Something I do as rarely as possible but my doc left Florida. (not a pill mill closure) As a 5 foot 3 woman that weighs little more than you and only 40yrs old my tolerance is high enough to also kill a linebacker. But the article said "saw up to 5 different doctors in a month" and mentioned they got stuff filled by all 5. Totally bogus as legit patients know - doesnt matter if private insurance or Medicare. And now they will catch the cash payers. (which should ease our suffering eventually)

Cheers :hug:

Sandy

[kag]

14. I get it.

I live in fear that my clinic will get closed down. My doc there (and she's really a PA) has saved my life, as I'm sure you understand. I'm also on a first-name basis with my pharmacist. For a while he was the only independent pharmacy in the area, until he finally sold to a larger company. Fortunately they didn't shut down, just changed pharmacists, but it was a pretty seamless transition. I do my best to use him for everything, even my family's antibiotics and inhalers and stuff. I don't even think about going to other pharmacies unless absolutely necessary, and even then, I check with my doc before doing so.

I agree the stuff about 5 docs in one month is ludicrous. That's an obvious drug-seeker. My clinic has had to weed out some of those folks, and I think all of us legit patients are glad that they do. The sellers and abusers only make life harder for those of us who need the medicine and follow the rules.

Good luck finding a clinic. I know that can be pretty anxiety inducing, on top of the daily pain. Take care.

and :hug: right back atcha.

[axollot]

17. It just cannot be stressed enough how important the pharmacy

is in the pain mngt regime. First name basis here too, they treat me well. Make sure to hold my meds when time is due rather than let an unknown patient come in and take them all (which is a bummer too but glad they do save me). If they are "low" I will not even go to another pharmacy (though my doc said it was OK for me to do "in good faith" then I explained to him how people without a relationship with their pharmacist are turned away and told "they do not have that med and will never have it" - Walgreens to me once) That made him really sad. And I said welcome to the world of CPPs.

I am with a new doc, he's a good doc but gun shy right now. His trust is growing with me but I had to change to him in July. That's Ok though. Dealt worse blows than this one.

It's a tough world for the new CPP out there and if you don't know the rules you can easily get screwed over. That's why I send everyone to www.painfoundation.org they have so much available in resources.

Cheers hun
Sandy

[axollot]

10. Exactly! I wrote the guy at the NYT about this - now

if they meant they busted folks with insurance, including Medicare committing fraud by doctor shopping and paying cash to get double scripts that would be believable but this story is bogus to chronic pain patients. And, now the data-base system is in place in FL and will take out the shoppers paying cash.

cheers
Sandy

[axollot]

2. Check out: http://www.painfoundation.org/ eom

[groundloop]

4. I believe there's a real problem which needs to be addressed....

I personally know someone who goes doctor shopping to get prescription painkillers for recreational use and to sell. It's an unfortunate situation where a small percentage of people abuse a system set up to assist people who genuinely need Medicare, but it's a problem that needs to be addressed.

On a side note, the individual I know is currently in jail for selling prescription meds, where she is receiving no counseling or treatment which will lead her to be a better member of society upon release from jail. Instead of housing a prisoner for many months and then turning them loose to go right back to their previous life, our taxpayer money would be better spent to treat those people with substance abuse problems and give them a better shot at becoming productive members of society.

[jwirr]

7. How does this person get the prescriptions filled? When I call my

medications in to be refilled there is a record of when I last called. If it is too soon the pharmacist calls me back and refuses to fill it. Also our meds are given out in small quantities because that prevents the user from selling them. Medicare/Medicaid has strong rules that are meant to prevent what you are talking about.

Who is allowing this to happen? Or is the person crossing state lines? Setting up two totally different identities?

Hopefully the new computer system which allows other doctors to check out the history of a new patient will help this but it is not yet sharing with everyone. Our clinic shares with our hospital and pharmacy but not with the diabetic educators in the hospital.

[DesertFlower]

6. i had a hell of a time getting a prescription for

vicodin which i occasionally use. finally my naturapath wrote it for me which is unusual. they usually try to use natural remedies. i have health insurance. 30 pills cost 87 cents.

[defendandprotect]

8. Big Pharma are the biggest criminals re Medicare -- !! And overall threat to patients -- !!

We are still paying much more than any other nation for our prescriptions --

and not only is Big Pharma getting full price from Medicare --

they are defrauding Medicare at every opportunity !!

See Sen. Bernie Sanders on that -- !!!

[kag]

18. Yes! Big Pharma are part of the problem.

They slightly change the composition of a drug, and then slap a new patent on it and sell it for hundreds of bucks more than the generic would cost. I think the insurance companies must be in on it somehow, because they pay it quietly...at least in my experience. It's a total scam.

I took my kids to a dermatologist. My son needed Retin-A for acne, and my daughter needed some prescription strength cortisone for some eczema. The doc handed me a script and a "coupon" for each script. The "coupon" says I'm not supposed to pay more than $1 or something like that for each script. I'm supposed to hand that "coupon" to the pharmacist. He's supposed to call my insurance company (meaning staying on hold for an ungodly amount of time) to "activate" the coupon.

Well, I didn't want to do that to my pharmacist, whom I like, and who knows me and my family well. So I went to my family doc and got scripts for generic Retin-A and cortisone, paid a $5 copay for each, and was happy.

There's an obvious scam at work here.

[iscooterliberally]

9. It's OK to suffer in agonizing pain but...

...god forbid anyone gets high. I think it's absolutely insane the way our country handles drugs. As an adult over 21, I can drive a several ton vehicle that's equipped with high powered firearms, several large and potentially dangerous dogs, and a trunk full of booze. I should be able to walk into a pharmacy with my ID, and buy an $8 bottle of percocet or vicodin without a prescription. I was in a motorcycle wreck a few years back, and it was like getting body slammed to the pavement while moving at about 40 mph. I don't recommend the experience to anyone. I live in S. Florida and could visit one of those 'pain clinics', but I'm not about to drop $300 cash just to get an $8 bottle of pills. What an EVIL racket this is. Those in need suffer while those in greed profit. I have learned to manage my pain without this stuff, but my heart goes out to those of us who cannot turn to anything else. We need to repeal the controlled substance act. It is the cause of the new slavery in the country. :grr:

[axollot]

15. Thankfully, they closed those jerks down. It was owned by

two brothers (nearly all of those "pain clinics" in S. Florida. I live in NE FL) who didnt have a medical license of any kind. They wrote the max to everyone that went there (the doctors were told to and given bonuses for doing it) so they could "hook" pain patients both legit and dealers.

I am thankful those are closed, I am saddened by the ignorance of pain and the multi-pronged approach often needed to treat dif types of pain. (myself a smoke - especially good smoke, which I cannot get here and new doc is against my use with my meds.) and meds are required.

Not everyone heals the same way from accidents and injuries. some people never do (my CNS is perm set to "ON" and sends pain signals to the brain all the time though muscles mostly healed. That's nerve damage for you tho)

Plus I have herniated disks and a host of other problems. Yeah it makes me angry too.

Cheers
Sandy

[kag]

20. Is that where Rush was getting all his drugs?

Or...sending his housekeeper out to do it for him? Probably.

And anyone who thinks he's "clean" now, I got a bridge to sell ya'.

[axollot]

23. Not likely - those clinics opened after Rash went through his ordeal

however, Rush should have been prosecuted for doctor shopping. There was really clear evidence he did it. If I did what he did (not including the street tablets he was getting from the housekeeper) I would be in jail for LIFE. That was how many charges would have racked up on him. It would be over 25yr sentence.

He never even went to court.

He makes folks like us look even worse and that asshole acts all sanctimonious about criminals but he's the biggest one of them all!

cheers
Sandy

[iscooterliberally]

21. I read about the 2 brothers.

I'm glad they got shut down too. The problem is that regular honest doctors are now afraid to write a script for anything that might be abused. There were a lot more clinics down here than just those guys. I called one and spoke to them. They only took cash, so my insurance would not work. That was a non-starter for me right there, but they really wanted to get me in when I told them my story. Anyway thanks for the advice that you posted earlier. I'm OK for now, but if things get worse I'm going to try and follow your plan. :toast:

[Trillo]

12. I don't believe this story, reads like fiction.

I'm not on medicare, but have been in severe pain for more than 10 years, and complained every time I've seen him and his staff. I've been unable to get my physician to even write a note on my medical record that I've complained of pain. Honestly, it seems more like they are collecting data and money and refusing to treat.

Thus, the concept that there are physicians out there that will write scripts for pain meds is completely alien to me. Call it cognitive dissonance.

My guess is some corporations are doing some rather creative accounting to make it appear like medicare patients are bilking the system.

[axollot]

13. Hey hun. You should not be t reated like that, but it's a fight

one I have battled for over 10yrs. Please check out the site www.painfoundation.org and they have an advocacy site called painaide.org it's at the link.

1st since your doc will not even note your records, I would suggest changing doctors. If that is just not an option, then the site has a print out you can bring in since it's illegal to deny your pain or tell you "it's all in your head" - a doctor must take proper steps to treat pain seriously.

2nd. make a list. List your daily pain in a 1-10 manner - one being the least/no pain and 10 the worst pain ever.

Make a journal of where, when, how you have pain on a day by day basis and all other issues and bring that in to your next appointment too.

You have to be proactive to get anything done. Ask them (depending on your pain) if you need MRI/CAT Scans/Blood Work etc.

I have done pain advocacy as much as humanely possible since being treated like dirt in the early days of my chronic pain. And trust me I went through hell, was called an addict, drug seeker, all sorts of bullshit. Once I was able to grab a hold of the reigns of my medical care (and why I am now on SSDI with Medicare and only 40) it's been much better.

If a doctor knows you KNOW and you do your research and homework - you will get better respect. If not, report your doc and find a new one. The difference between shopping for a doctor and doctor shopping is walking out of the building with a prescription. If you see a doc and do not take any prescriptions from them (scheduled medications i.e. narcotics either pain meds or benzodiazepines) you are safe and playing it legal.

Finally, and maybe one of the most important steps in pain management. Use only ONE pharmacy - EVER. Get to know the manager of the pharmacy and their staff. Let them know why you are prescribed xyz and what your health problems are etc. It pays off in dividends if you have to change doctors for any reason you have a strong medication history built up and relationship with your pharmacist which may out last any you have with a doctor.

Good luck to any and all suffering folks out there.

Cheers :hug:
Sandy

[kag]

16. Yes!

Listen to Sandy. She knows what she's talking about.

There ARE good pain management docs out there, but you have to find them.

And the admonition about ONE pharmacy is absolutely on target. Knowing your pharmacist can make life drastically better.

Good luck.

[axollot]

19. Aww thank you! It really chaps my bum to hear about people being

poorly treated over their pain. Any concern over addiction has been proven to be unfounded. Drugs like Cymbalta are not listed as a narcotic but are actually highly addictive (they make me sick too). Yet those are pushed over the cleaner option of morphine, methadone, oxycodone (or even oxycontin for those that do not know that's the 12hr version).

And then there is the nasty of the nasty drugs - tylenol aka acetaminophen. The number 1 cause for liver transplants in the USA and sold by the hundreds per bottle OTC. Crying shame.

Cheers again to you Kag! :hug:
Sandy

[Trillo]

22. Thank you for your kindness.

I've been experiencing this kind of treatment from doctors for so long that it's WAY PAST my point of willingness to deal with it.

But I did want to write out a reply that thanked you for your thoughtful response.