Another proposed discrimination of pts with non-cancer pain ?

Congress, Help Combat Prescription Drug Abuse | Commentary

Prescription drug abuse has become an epidemic, with 16,000 people dying in the United States each year from overdoses of prescription pain relievers. In 2011, the most recent year for which reliable data exists, nearly a quarter of a million Medicare beneficiaries took potentially life-threatening doses of these drugs for extended periods.

To tackle this epidemic, we must do a better job coordinating medical care. Patients in pain often go to multiple doctors and pharmacies, making it difficult for any single provider to know if a patient is taking too much pain medication — and allowing some patients to obtain dangerous amounts of opioid drugs.

Fortunately, we know one way to solve this problem. Drug management protocols known as patient review and restriction programs allow state Medicaid and private insurance plans to make sure at-risk patients receive opioid prescriptions from only one doctor and fill them at only one pharmacy. The programs apply just to controlled substance prescriptions, and patients taking opioids as part of cancer treatment or hospice care are excluded. Patients work with their health plan to choose the one doctor who will prescribe their pain medications and the one pharmacy that will dispense them. And patients can choose different physicians and pharmacies for any medical needs other than their prescriptions for controlled substances.

The result is that the doctor and pharmacist improve care coordination and patients have access to the pain medication they need while lowering the risk of overdose.

Experts convened by the Centers for Disease Control and Prevention concluded in 2012 that PRRs have the potential to save lives and lower health care costs by reducing opioid use to safer levels. These programs have already yielded benefits for patients enrolled in them. In Oklahoma, Medicaid patients in a PRR program used fewer narcotic medications, decreased their visits to multiple pharmacies and physicians to obtain these drugs, and made fewer visits to emergency departments. Opioid doses were reduced by 40 percent for patients enrolled in the Ohio Medicaid PRR program.

The problem is that current federal law prevents Medicare from using PRRs. But there is significant bipartisan momentum building for change: the House Energy and Commerce Committee has included a bipartisan PRR provision as part of its 21st Century Cures initiative; the House Ways and Means Committee considered a similar bipartisan proposal; and the president has also signaled his support for the policy when he proposed establishing these programs in Medicare as part of his 2016 budget request to Congress.

With PRRs, we can give doctors and pharmacists the ability to better coordinate patient care. We can find those patients at risk of drug abuse. And we can address the unnecessary epidemic of deaths from prescription drug overdoses. These programs are a promising tool, but only if Congress grants Medicare the authority to use them. Our congressional leaders should work together to make that happen.

Cynthia Reilly directs The Pew Charitable Trusts’ prescription drug abuse project.

The 114th: CQ Roll Call’s Guide to the New Congress

10 Responses

  1. Last week @ visit to my PM ciinic I was told by the nurse that they had received a PHARMACY FLAG for yours truly from MEDICARE.
    Nurse: Just a ‘mix up’. [For obtaining Rx from multiple doctors for same Schedule II pain med].
    Turns out they were both from the same practice, at the same address, and for the same medication and same number of days (30). These were 2 docs at my PM clinic THE SAME ONE THEY SENT THE DAM FLAG TO!!!!! The ‘other doctor; writes my script when my regular doctor is not in the office. (two locations)

    The clinic is obviously not a ‘pill mill’, it is located at a REGIONAL MEDICAL CENTER. I travel over 1&1/2hr (one way)to receive care at the hospital (other than PM). It is difficult to find physicians that know anything about my diseases.

    It is not always possible to schedule multiple doctors from Rheumatology and PM for the same day spaced apart enough to allow for me to be sure not to miss one. Sometimes that means seeing the Nurse Practitioner, who does NOT write the Rx, but takes them to one of the other doctors (not mine) who is there and they sign them.

    IF Medicare and the good legislators care so much about me, why has my grievance against BC/BS and the hospital gone 6 mos w/out being addressed when you are told it will take 30 days? (I can see now why the PIC was unimpressed when told him i would be reporting him to CMS).

    I am literally falling apart at the seems, it seems w/ almost every system in my body involved includ GI, endocrine, autonomic nervous system, pulmonary, muscles, skin, lymphatic system, blood, etc, etc.
    still they have no qualms about me having to travel ANOTHER hour round trip to fill them by my home. Every pharmacy asks the obvious, why didn’t I just fill it at the hospital? Somehow I refrain from saying- that’s a great idea I never thought of that, MORON!! (I was ‘assigned’ to use only one of the medical center’s 7 pharmacies (all in-network and OPEN TO THE PUBLIC) despite being a patient there for almost 6yrs now). If they are out? Tough sh** not their problem.

    Dangerous levels? There is no ceiling for opioids, depended on the patient’s tolerance. Fact being, what might kill patient A, might not be enough for patient B. I am certain that the legislature knows better than the physicians what ‘dangerous’ levels are though. What is dangerous is usually not the opiods, its the idiots who take them with Xanax and a Jack Daniels chaser, most not a patient of ANY doctor.

    And these are the geniuses who are going to ensure that we receive good care? The same ones that can’t sort out two docs from same clinic/hosptial syatem/and address? God help us.

    • This is what happens when you delegate the decision making process to a computer program, written by a programmer that has no idea of the real world is really like.. I suspect that the computer looks for a single pt that has Rxs filled by prescribers with different NPI/DEA numbers.. and didn’t tell the programmer to have the computer to look at the office address of the prescribers.. to see if they are in the same practice. I just wonder how many healthcare professionals are getting these warnings and not do an evaluation of the report themselves. I know that I have pulled PMP reports on pts and at first glance.. I saw a “problem pt” .. once I looked at line by line… the facts corrected my first impression.

  2. Medicaid doctors many times are NOT as good quality as regular Medicare doctors! What about “snow birds” who are out of state for extended periods of time? Or pain patients who have out of state (or out of country) emergencies? That isn’t even addressed! We are not “permitted” to have a life other than seeing a doctor and having our every move scrutinized and perceived as “drug seeking” or “doctor shopping”.

    Stop controlling patients in pain and treating everyone as irresponsible because of the very small percentage that the “experts” “claim” are overdosing!

    16,000 “supposed” deaths from opioids is what percentage of the 100 million patients in pain? That is hardly an “epidemic” and the data is manipulated to fit an agenda aimed at exploiting the 100 million pain patients, and to extract as much income from their suffering as possible.

    • Are you presuming that all 16,000 of those deaths were chronic pain pts ? If some of those 16,000 were chronic pain pts… were their deaths not “accidental” and really a suicide ?

  3. `There is nothing new about patients only seeing one doctor for PM and going to one pharmacy (in a normal world) to get their medications filled. This has been standard procedure for a long time, especially for patients who have trouble walking or driving as do most who are disabled and suffer with chronic, intractable pain. Personally, because I have had to go to a doctor every single month for the past 25 years due to disability and medical issues, I am not as likely to go to other needed medical appointments as it is a strain for me to do a ‘doctor day.’ If someone is able and willing to go to many doctors in one month I would think either they aren’t really feeling so bad or they are having to get treatments for cancer or something else. So I’m not really sure what kind of point this very outdated article is trying to make. If someone takes too many drugs or whatever substance to kill themselves, does it really matter after the fact what they took to bring on their death? Do these people who want to babysit adult Americans and control their lives want to take some kind of credit for deterring deaths by withholding necessary medications from patients who need them? That does not make any sense to me. People who require medical treatment deserve to have that medical treatment from a qualified medical doctor, not some politician or shop-keeper.

  4. Jami, this poor overly controlled patient (who is being overly controlled for their own “benefit” (yeah, right!) is SCREWED!!!!! No doubt they’d have to call some not so helpful bureaucrat for an over-ride of some sort, come back later (what if they have to pay for a cab???) Can’t we just say that adults will make decisions that aren’t always right, but that we can’t punish everyone to protect those that make bad decisions????

    • Personal responsibility. It is a concept that is over the heads of those accustomed to being ‘cared for’ and ‘looked after’. Nanny State 101.

      Don’t forget their motto: when something goes wrong in my life SOMEBODY ELSE must be to blame for it.

  5. And what is this overly controlled patient to do if there is one allowed pharmacy doesn’t have their medication?

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