Drugs and Patient Safety – the Disconnect
The recent Washington Post piece published May 11, 2013, on the prescription drug dangers for Medicare patients raises some interesting points about the current prescribing habits of some outlier physicians/prescribers, as well as the lack of a coordinated effort to exclude those same prescribers from participating in Medicare.
The use of atypical antipsychotics (identified by CMS as protected class drugs) in the elderly is particularly troubling in light of numerous studies and a FDA Black Box Warning which states in part “Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. Although the causes of death were varied in clinical trials, most of the deaths appeared to be either cardiovascular (e.g. heart failure, sudden death) or infectious (e.g. pneumonia) in nature.” Those with family in Long Term Care facilities or those working in LTC settings know that the staffing model is dependent on quiet, non-disruptive patients—unfortunately atypical antipsychotic medications are often used to ensure that scenario.
The High Risk Medication list or revised Beers criteria is one of the Part D performance or Star measures. Part D sponsors have been fairly successful in the past couple of years at deleting these drugs from the formulary or adding a CMS approved prior authorization edit for > 65 years old. Has this completely eradicated the use of drugs like carisoprodol (Soma) or cyclobenzaprine (Flexeril)? No, but physicians do have to provide a medical necessity explanation or describe why the benefit of using the drug outweighs the risk.
More troubling and potentially in most need of action is the inability to exclude those “prescription mill” physicians/prescribers from participating in Medicare. The data available to plan sponsors listing the highest volume opiate prescribers is actionable information. Where documented, proven and egregious prescribing behavior is found, State Board, Medicaid and Medicare exclusion should be a logical outcome and the best route to enhanced patient safety.
Resources:
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