Journalism in the Public Interest


Podcast: Behind Our Prescriber Checkup Investigation

As we continue our investigation into the lack of oversight of the drugs prescribed in Medicare’s Part D program, senior reporters Charles Ornstein and Tracy Weber sat down with Steve Engelberg to talk about the project and their latest findings.

The trio discussed the difficulties in obtaining the prescribing data, why pharmaceutical companies already knew what was being prescribed, how doctor’s responded to the data being made public and what Medicare could do to improve Part D prescribing.

“It doesn’t necessarily take legislation to get change in this program,” said Ornstein. “It could share information with state medical giving them the information they can use it as part of their investigations. It can allow insurers to talk to one another and share with them a doctor’s prescribing across all plans and not just within their narrow slice of plans. One of the things we identified is that doctors who were under criminal charges for defrauding the Medicare Part D program were still able to prescribe within the program. And the former administrator of Medicare said, 'This makes no sense. The agency can do something about this and should.' So these are not all really sophisticated solutions that would require an influx of billions of dollars. A lot of these are just common sense solutions that require a will to make happen, and I think with some congressional pressure, may actually begin to happen.”

Can’t thank you enough for this valuable information.  I began looking at your data as a nursing home reform advocate and am appalled by what I see some of these Kentucky doctors prescribing.  There is obvious fraud going on here that is being ignored.  For anyone to consider cutting back Medicare or Medicaid services to those who need it and continue to ignore this fraud is absolutely unconscionable.

Leonora Nelson

June 28, 2013, 11:42 a.m.

RE: United Healthcare’s AARP Medicare Complete. The question: When is part D coverage not really coverage. They have started a new way to cover Glaucoma drops, by the drop. Every drop is counted and if the 10 ml bottle has 66 days of drops, That is 3 copays of $45 each.. EX: 30+30+6. for the third copay of $45 you get just 6 days of drops. Eye drops are not like pills. When you miss your eye you lose the drop but when you drop a pill you can still retrieve it. I use 4 different glaucoma drops and I have to admit that that I lose drops almost every day from one medication or another. The 3 copays is more than what the drug costs the insurance company so I am really not covered as I could go out to Costco or elsewhere and just but a 10 ml bottle as that is how they furnish it. This method seems to be new as my records show that previous refills were filled at a single copay and the insurance company paid $79.86. The company would thus require me to pay $124.86, the total cost of the drug. That still leaves me with the problem that for the third month I have drops enough for only 6 days. That is if I do not lose any. This is not the only glaucoma drug that is computed in this way. You should go to their site and check on the price of Azopt. The formula they use is totally whacked. It comes to an annual cost of about $14,000. Figure that for building patient confidence.

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