By Rebecca Adams
Federal health officials issued a guidance on Tuesday that will help Medicare prescription drug plan officials restrict the use of medications, such as Oxycontin, that are often abused.
The guidance is part of a larger effort across the Obama administration to improve efficiency.
Health and Human Services Secretary Kathleen Sebelius told reporters on a phone call that the guidance allows Part D plan executives to withhold payments to pharmacies if they suspect fraud, such as in cases when enrollees use multiple doctors to obtain painkillers and narcotics such as Oxycontin and Percocet.
While HHS generally requires prompt payment, the guidance clarifies that if plan officials believe they see signs of fraud, they should not pay a claim until they verify its validity. The document also makes it easier to report suspected fraud and encourages plans to shorten the length of prescriptions if fraud is suspected.
HHS officials said the Government Accountability Office reported that “170,000 Medicare beneficiaries received prescriptions from five or more” doctors for drugs that are frequently abused, including Oxycontin and Percocet.
Sen. Thomas R. Carper, D-Del., praised the administration’s efforts to do more to control the misuse of prescription painkillers.
“Today’s announcement to go after Medicare recipients who try to game the system and engage in ‘doctor shopping’ is something I’ve encouraged the Administration to do for a while now,” said Carper, who had requested the GAO report. “Every dollar these bad actors steal from the Medicare system is one dollar less for the individuals who really need this care. I am encouraged that the Administration heeded my advice and the advice of the Government Accountability Office to tighten up control of the program and help curb dangerous misuse of prescription drugs.”
Sebelius said she does not have an exact cost savings estimate for the move, but she called it a win-win situation. “We go after fraud and also will have a reduction in underlying drug costs,” because Medicare will see a reduction in medical problems caused by painkiller abuse and fewer emergency room visits related to abuse, she said.
During the same announcement, Treasury Department officials said that they will stop production of new $1 coins. They said that they have 1.4 billion surplus coins — enough to meet demand for more than a decade — sitting in Federal Reserve vaults because consumers did not want them.