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.
