Waging War on Prescription Drug Abuse: New Medco Analysis Reveals Prescription Drug Abusers Engage in Doctor Shopping and Script

Waging War on Prescription Drug Abuse: New Medco Analysis Reveals Prescription Drug Abusers Engage in Doctor Shopping and Script

News and Commentary | Links to Press Releases | Prescription Drug Fraud
  • Half of all documented cases of prescription drug abuse and drug seeking (fraud) are aged 40-49 years old
  • Monthly drug costs nearly 7 times that of average patient
  • Medco deterrent program decreased abuse by 32 percent; costs by 20 percent

FRANKLIN LAKES, N.J., Sept. 29 /PRNewswire-FirstCall/ — A new data analysis released today by Medco Health Solutions, Inc. (NYSE: MHS) provides a striking profile of people who file excessive prescription claims for drugs of potential abuse and how their risky habits are bilking the healthcare system.

According to Medco’s analysis of more than 1,000 prescriptions for patients identified for excessive prescription drug use, 50 percent of those patients were older than you might expect — between the ages of 40 and 49, representing more than four times the number of high utilizing members between ages 20 and 29, and 11 times the number between 30 and 39 years of age.

The profile analysis revealed these members likely engaged in serial acts of “doctor shopping,” and received multiple concurrent prescriptions that were filled by numerous retail pharmacies. On average, monthly prescription spending by high utilization patients during the three-month analysis period (first quarter of 2004) exceeded $400, nearly seven times the monthly drug costs of members without excessive prescription claims.

“This analysis presents a stark contrast to widely accepted views on prescription drug abuse and prescription fraud, and may provide the clearest picture of who these people are and how they are trying to subvert the system,” said Dr. Glen Stettin, vice president, plan management, Medco. “The costs of abuse and fraud are staggering for the healthcare system, and present a clear challenge that physicians, pharmacists, and benefit sponsors must collectively address.”

Among the major findings of the Medco analysis:

  • Members identified in the high utilization category filled prescriptions at five different pharmacies and received prescriptions from six different doctors. Some members received prescriptions from as many as 21 different doctors.
  • Nine out of 10 prescriptions presented for dispensing by a member who filed excessive claims were dispensed from a retail pharmacy.
  • Nine out of 10 cases of high utilization identified during the analysis period involved excessive claims for narcotics (opioids). Anti-anxiety medications, muscle relaxants and hypnotic agents comprised the majority of the remainder of cases.

The Medco analysis also found that a high utilization management program was instrumental in identifying potential abusers and restricting them to the use of a single pharmacy, thus reducing excessive drug utilization by 32 percent among the high utilization population and decreasing benefit sponsor drug costs by nearly 20 percent.

A recent study by The National Center on Addiction and Substance Abuse (CASA) at Columbia University uncovered gaps in healthcare management that open the door for manipulation of the system by patients through “doctor shopping,” forgery and deception. According to CASA, more Americans are abusing controlled prescription drugs than cocaine, hallucinogens, inhalants and heroin combined. The study found that 40 percent of physicians do not ask about prescription drug abuse when taking a patient’s health history, and one-third do not regularly call or obtain records from the patient’s previous (or other treating) physician before prescribing a controlled substance. Physicians also cited doctor shopping, patient deception of doctors and forged and altered prescriptions as the primary mechanisms of prescription diversion.

“There is a clear need to support the clinical care team with the tools that are necessary to help them identify patients who may be manipulating the system,” said Stettin. “High utilization review systems are one of the secret weapons in the war on prescription drug abuse, and have a valuable place in the arsenal against this type of behavior.”

Solution to the Ills - High Utilization Management

To address the growing epidemic of prescription drug abuse and fraudulent activity, Medco has developed clinical management systems including its high utilization management program and RationalMed® Patient Safety Solutions that identify patients attempting to fill inordinately high or excessive quantities of prescription drugs within a given time frame.

Medco’s high utilization management program reviews medications within certain drug categories that have the potential for abuse including tranquilizers, skeletal muscle relaxants, narcotic cough and cold, anorexients/amphetamines, narcotic analgesics, non-narcotic analgesics, barbiturate sedative-hypnotics, and non-barbiturate sedative hypnotics.

Alerts are triggered when:

  • Multiple prescription claims are filled by one patient within 90 days
  • Multiple doctors and multiple pharmacies are used by one patient to obtain medications
  • Excessive accumulation of days of therapy are dispensed during a 90-day interval for one patient

Once potentially abusive patterns of prescription drug usage are identified, physicians are notified and provided with the patient’s complete drug history, guidelines to curb abusive drug use and an option to limit the patient to the use of a single pharmacy. Many of Medco’s clients, including several state employee benefit programs, participate in the company’s high utilization programs.

540 narcotic pills - a case study

One particular case provides an alarming view of the problem. A patient identified by Medco’s high utilization management system had received prescriptions for the narcotic pain medication hydrocodone - a controlled substance known to be addictive - from six different doctors and attempted to fill them at three different pharmacies over a three-month period. Collectively, the prescriptions amounted to 540 pills.

Once the patient was identified, Medco alerted the prescribing physicians and dispensing pharmacists. In response to the alert, one physician contacted by Medco replied: “I was not aware that she was getting the medications from other doctors. I have instructed my staff that we will not be providing any additional narcotic analgesics unless it becomes necessary.”

In addition to the high utilization program results, RationalMed’s over-utilization and therapy duplication rules delivered more than 4,200 alerts to more than 37,000 physicians in 2004 related to therapy duplication of narcotic agents. Physicians agreed to make therapy changes or stop therapy altogether nearly 70 percent of the time they were alerted to a problem.

“Doctor shopping and filling prescriptions at multiple pharmacies are common vehicles for those looking to subvert the system at the gross expense of health plans and employers,” said Stettin. “Fortunately there are programs in place like our high utilization system that can identify these practices and act on that information to prevent abuse and fraud, and save our clients significantly on their healthcare costs.”

About Medco

Medco Health Solutions, Inc. (NYSE: MHS) is a leader in managing prescription drug benefit programs that are designed to drive down the cost of pharmacy healthcare for private and public employers, health plans, labor unions and government agencies of all sizes. With its technologically advanced mail-order pharmacies and its award-winning Internet pharmacy, Medco has been recognized for setting new industry benchmarks for pharmacy dispensing quality. Medco serves the needs of patients with complex conditions requiring sophisticated treatment through its specialty pharmacy operation, which became the nation’s largest with the 2005 acquisition of Accredo Health. Medco, the highest-ranked prescription drug benefit manager on Fortune magazine’s list of “America’s Most Admired Companies,” is a Fortune 50 company with 2004 revenues of $35 billion. On the Net.

This press release contains “forward-looking statements” as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements involve risks and uncertainties that may cause results to differ materially from those set forth in the statements. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. We undertake no obligation to publicly update any forward- looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this presentation should be evaluated together with the risks and uncertainties that affect our business, particularly those mentioned in the Risk Factors section of the Company’s Annual Report on Form 10-K filed with the Securities and Exchange Commission.

SOURCE Medco Health Solutions, Inc. Web Site: http://www.medco.com