IF I was a drug diverter !

These bureaucrats are so smart… they are expanding a 1990’s system (Prescription Monitoring Program -PMP) … there are still a hand full of states that still don’t have a system in place.. They are even starting to get various states to link together.. so that searching one state’s system will also concurrently search others.  First of all .. they have mandated that pharmacies must transmit Rx data for controlled substances filled.. most of these submissions are done transparently from the Rx dept staff…but.. many states.. require that a Pharmacist must “sign up” .. sometimes even having a form validated by a notary public… Try to get a report back from one of the PMP can be somewhat laborious .. I have seen systems where I  have had to print out 2-3 screens to get all the necessary data points to manually input that information into the PMP website and then wait for a fax or email with the report attached… which can take seconds.. minutes.. hours.. great for workflow.. We have to ASK for a SSN or a driver’s license as ID… no validation here.. just accept it at face value.. and send it off to the state’s database.

If  I was a diverter… I would find  some people that needed some money and have Medicaid or a drug card.. prefer Medicaid.. since there is a low or no copay.. Then round up one or more people who could actually pass a prescriber’s exam as needing some opiates.

I would then get the necessary supplies to generate fake ID’s driver’s license or the like… just Google “fake driver’s license” if you don’t think that it is easy to do. I would then create fake ID’s to match the “borrowed” Medicaid card and send the person off to see whatever prescriber they can get into and get a Rx written for controlled substances. Same person can go to multiple prescribers.. just with different ID’s… once into a prescriber’s practice… just keep sending this person back every 30 days to get refills.

So this great PMP program… the  prescriber checks the database to find little or no scheduled drugs filled for the person in front of them… acute case of confirmation bias… the PMP doesn’t show any unusual activity.. the same thing for the pharmacy…

The diverter doesn’t even have to go to the prescriber…  the “patient” will get X dollars/cents for each tablet the Rx is for … more for Opana & Oxycontin.. less for Hydrocodone…the person that “loaned” their drug card gets a similar “cut”

How many prescribers could these “patients” see??? one …two…three a day… 5 days a week.. and then get into a monthly cycle… and each healthcare professional checks the PMP and nothing shows… nothing shows up at Medicaid or the insurance database… Nothing shows up at the Pharmacy.. even if they are being filled at different outlets of the same chain.. since different names are being used…

The diverter is using the Medicaid/insurance system to pay for his “cost of goods” and most of his “cost of doing business”…  copays – if any at the prescriber’s office and copays – if any – at the pharmacy…

If the diverter is really technically advanced.. once they get the first Rx from a prescriber… they start generating Rxs once a month of what was previously prescribed and eliminate that “middleman” from the process.

Drugs are getting to the street and everyone is scratching their heads or other parts of their anatomy… wondering where all these drugs are coming from?

Be grateful that the only reason that they are not paying for all these meds with a “rubber check” is that it would call attention to them and might start looking at Rx that the check was used to pay for.

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