In an effort to tackle prescription painkiller abuse in South Carolina, the state will soon require most Palmetto State physicians to search for their patients’ medical history in a statewide database before billing Medicaid or the state health plan.
Since 2008, the use of the database has been voluntary. The new mandate will take effect April 1.
Inspector General Patrick Maley recommended the mandate in a report that ranked South Carolina 11th highest in prescribing painkillers nationwide, with 102 prescriptions written for every 100 people.
In the last fiscal year, 291.4 million opiates were reportedly dispensed to 1.2 million patients across the state; which turned out to be 18.6 million more opiates dispensed than the previous year to 670 fewer patients.
In 2014, at least 487 South Carolinians died from accidental prescription drug overdose, which was an increase from 236 in 2013 and 225 in 2012.
Using the state database helped law enforcement make 400 arrests last fiscal year, with charges including controlled substance fraud, doctor shopping and prescription forging.
In its 2015 Policy Agenda, the Pharmaceutical Care Management Association (PCMA) outlined several initiatives to combat the prescription drug issue. One of those priorities was the creation of a “Lock-In” program in Medicare Part D plans. Such a program would require at-risk beneficiaries to select one pharmacy to fill their prescriptions.
“By authorizing this program, policymakers can combat prescription drug abuse and fraud in Medicare by enhancing the current system to make it more difficult for drug-seekers to obtain fraudulent prescriptions at the pharmacy counter,” Charles Cote, vice president of Strategic Communications at PCMA, told Palmetto Business Weekly.
Forty-six state Medicaid agencies operate "Lock-In" programs and 49 states have enacted prescription drug monitoring programs (PDMPs).
Cote said another option to reduce pharmacy fraud includes requiring drugstores and pharmacists to register with state Prescription Drug Monitoring Programs (PDMPs).
“PDMPs can alert pharmacists when someone is ‘drugstore shopping’ to acquire controlled substances. PDMP functionality is improving and pharmacies should be encouraged to use them,” he said.
Allowing payers to coordinate with state PDMPs can contribute to reducing prescription abuse.
“The overwhelming amount of prescription drug abuse occurs when prescriptions are paid for in cash. These purchases are never seen by public programs or private insurers,” Cote said. “Payers need access to prescription cash sales data in order to detect drugstore shopping. Access to state PDMPs provides this data and helps payers spot patterns of abuse.”
Cote added that providing Part D plans the same fraud prevention tools as in Medicare Parts A and B will go a long way in eliminating fraud.
“In Medicare Parts A and B, the entities paying claims — Medicare administrative contractors — have authority to suspend payments before claims are paid when fraud is detected," he said. "This is not the case in Medicare Part D. Congress should clarify that Part D plans can suspend reimbursements at any time based on a ‘credible allegation’ of prescription drug fraud, waste or abuse. Without this authority, drug diverters are emboldened, knowing that the Part D plans must pay claims when presented, even when they are likely fraudulent.”
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