Journalism in the Public Interest

Eight Ways to Strengthen Medicare’s Drug Benefit

Former government officials, analysts and researchers say Medicare could improve oversight of its Part D drug benefit with these steps.

President Bush speaks in December 2003 before signing the Medicare Modernization Act, which created Medicare Part D. (Photo by The Washington Post)

This story was co-published with The Washington Post.

Former government officials, analysts and researchers say Medicare could improve oversight of its Part D drug benefit with these steps:

1) Regularly analyze data to identify high prescribers of drugs that are frequently abused,  misused or particularly risky for the elderly. Search for those who prescribe drugs for patients outside the intended population, such as children and younger adults receiving Alzheimer's medications.

2) Compare prescriptions with patient diagnoses kept by Medicare's separate hospital and physician programs. Check whether drugs are appropriate for patients' conditions and whether doctors are prescribing without actually seeing the patients.

3) Require private insurers in Part D to report suspected fraud, waste and abuse to the contractor Medicare hires to look for fraud, a step recommended by the inspector general of the Department of Health and Human Services. Such sharing is now voluntary.

4) Seek congressional authority to suspend prescribers from Part D if they have been indicted or arrested on prescription drug charges or if they present an imminent risk to patients.

5) Require health providers to enroll in Medicare to have prescriptions covered by Part D. Enrollment requires providers to disclose past license sanctions and criminal convictions. Under the Affordable Care Act, Medicare can require enrollment in order to prescribe but it hasn't done so.

6) Routinely get prescribing records from state Medicaid programs, as well as the names of providers whom those programs have terminated — especially for improper drug choices.

7) Require diagnosis codes on prescriptions, at least for commonly abused or misused drugs, as some Medicaid programs now do and as recommended by the inspector general.

8) Share prescribing information with state medical boards, which license and discipline doctors.

These suggestions to “strengthen” Medicare Part D somewhat seem reasonable.  The problem is that things that somewhat seem reasonable are probably not good ideas. Taking these ideas in order:

1. How many children are there on Medicare? How many of that infinitesimal number are prescribed Alzheimer’s medication? It sounds like these left-wing Journolisters are proposing a bunch of solutions looking for a problem.

2. Checking whether doctors are actually seeing patients does not seem to be a Part D issue. To the extent it is an issue, it would seem to be part of the $60-plus billion fraud and waste problem in Original Medicare Parts A and B according to former temporary director Berwick. But I doubt that this is much of Part D issue.

3. Sure let them report fraud to the government.  Or—as is more likely the case—the insurers alreay police such issues themselves because it costs them profit.  That’s why the Part D program is wildly successful and so popular with us seniors

4. Criminal doctors should be suspended from Medicare period.  Why just Part D?  What are these Journolisters really talking about?

5. Same as four?  Did these Journolisters just want an even number of things on their list instead of an odd number? Is that some kind of Journolister superstition?

6. and 7. seem reasonable vis a vis Low Income Subsidy Medicare beneficiaries since LIS beneficiaries are often on Medicaid too.  But again is this just a bunch of ideas to employ more bureaucrats or is there a problem here?

8. Tell a bunch of doctors that there are some bad apples in the barrel.  I think they know that but “Why not?”

This article is part of an ongoing investigation:
The Prescribers

The Prescribers: Inside the Government's Drug Data

Medicare’s failure to monitor what doctors are prescribing has wasted billions of taxpayer dollars on excessive use of brand-name medication and exposed the elderly and disabled to drugs they should avoid.

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