For the past two years, US Senator Chuck Grassley has pressed all 50 states to provide data on doctors who write huge numbers of prescriptions for specific drugs that are paid for by Medicaid programs. Why? There were reports indicating certain meds - widely used antipsychotics and the OxyContin painkiller - have sometimes been prescribed at unusually high rates.
The underlying concern over prescription drug abuse that leads to unnecessary costs and deaths. "Over prescription of these types of drugs strains the financial viability of the Medicaid and Medicare systems and threatens the health and well-being of the American people," Grassley said last month at a hearing of the Senate Finance Committee Health Care Subcommittee.
The effort is an outgrowth of an earlier investigation into the financial interplay between physicians and the pharmaceutical industry. At issue has been the extent to which these relationships - which can take place in the form of research grants or fees for speaking and consulting - may unduly influence medical research and practice.
Initially, some states refused to comply with his demands. More recently, though, results have begun to trickle in and there are growing signs that some states are taking action against doctors who have been identified as high prescribers. For instance, Minnesota recently reported two physicians to its Board of Medical Practice for disciplinary action in connection with inappropriate prescribing (read here).
In Oregon, 67 prescribers, or 18 percent of 367 prescribers, were recently terminated from Medicaid contracts after a review of data from three years. State officials say most were due to business changes, but there were 15 specific prescribers who were terminated for loss of license, suspension or other disciplinary actions by the Oregon Medical Board (see this).
Simultaneously, Florida has been terminating contracts for high-prescribing docs to participate in its state Medicaid. The list was up to 10 physicians through January, according to documents provided to Grassley (look here, here, here and here). One also had his license suspended (read here).
The same approach is also under way in Iowa, where the state Board of Medicine is reviewing top prescribers and the state Department of Human Services identified OxyContin and Xanax as among the drugs for which some physicians have written a large number of prescriptions (read this, this and this).
"While the responses from the states are still being received, many states are still reporting a selection of top ten providers that are prescribing at rates double or triple that of their peers," Grassley said in a recent statement about the ongoing probe. "While some of these outliers are legitimate providers working in high-volume practices, such as mental hospitals, many cannot be explained away."
He cited one example in which the top prescriber of antipsychotics in Nevada wrote nearly 6,800 prescriptions for these meds in 2010 and 2011, which was more than 10 times other top prescribers. And this one doc accounted for $2.75 million in payments from Medicaid. By contrast, no one doctor in Colorado wrote more than 2,000 prescriptions for the same drugs over the same period.
"Out-of-control pychiatric prescribing is analogous to cutting the brake lines on society. We've already seen crashes - witness school shootings, depleted Medicaid coffers, children saddled with ignorant labels such as ADHD. Putting the brakes on out of control psych prescribers is a good first step," says Ken Kramer, who has investigated high-prescribing doctors for the Citizens Commission on Human Rights International, which objects to psychotropic drugs.