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Is Medicare Part D the New Doctor Shopping?



Is medicare part d and drug compounding the new version of the doctor shopping scam?

Doctor shopping. It’s a common tactic used by pain pill abusers to hide their opioid addiction. A patient goes to several different doctors and pharmacies for their prescriptions. Physicians and pharmacies are kept in the dark about their abuse and won’t cut off their drug supply. Recently, it has become harder to do with pharmacy databases, and strict punishment for doctors and pharmacies caught not adhering to federal laws.

That is great! Right? But there may be a new hole in the system.

Is Medicare Part D the New Doctor Shopping?

the new doctor shopping | growth in medicare part d spending on abused opioids

Medicare Part D has long been suspected as a way for opioid and other prescription drug abusers to cheat the system and get their high. In 2015, Medicare spending for regularly abused opioid medications was more than $4 billion. In fact, spending for these drugs rose by 165 percent from 2006 to 2015, though the number of patients who received Medicare Part D medications only increased by 76 percent.

In addition to the opioid abuse concerns, government investigators have another issue with Medicare Part D spending: compounded drugs.

Compounded Drugs: A New Subterfuge for Buying Opioids

the new doctor shopping |growth in medicare part d spending on compounded drugs
Compounded drugs are used when a patient has an allergy to a common ingredient, or can’t use a regular prescription medication. The compounded drug removes the particular component that causes the problem or changes the way it is taken. For example, the ingredients from an oral opioid may be added to a topical medication for patients who have difficulty swallowing. These medications require special compounding pharmacies, and they’re not cheap.

A recent study from the Office of the Inspector General (OIG) Medicare Part D has been paying an awful lot of money in compounded drug claims. In fact, from 2006 to 2015, spending growth for these medications outpaced spending for all other Part D medications.

In the course of the OIG investigation, it was found that some compounding pharmacies paid doctors a commission, or kickback, to prescribe compounded drugs. In some cases, the compounded drugs were found to be medically unnecessary. Unneeded oral and topical painkillers were prescribed to patients by doctors they’d never even seen.

Judge for yourself in this June 2016 report from the Inspector General of HHS: https://oig.hhs.gov/oei/reports/oei-02-16-00290.pdf


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