-- Half of all documented cases of prescription drug abuse and drug
seeking (fraud) are aged 40-49 years old
-- Monthly drug costs nearly 7 times that of average patient
-- Medco deterrent program decreased abuse by 32 percent; costs by
20 percent
FRANKLIN LAKES, N.J., Sept. 29 /PRNewswire-FirstCall/ -- A new data
analysis released today by Medco Health Solutions, Inc. (NYSE: MHS) provides a
striking profile of people who file excessive prescription claims for drugs of
potential abuse and how their risky habits are bilking the healthcare system.
According to Medco's analysis of more than 1,000 prescriptions for
patients identified for excessive prescription drug use, 50 percent of those
patients were older than you might expect -- between the ages of 40 and 49,
representing more than four times the number of high utilizing members between
ages 20 and 29, and 11 times the number between 30 and 39 years of age.
The profile analysis revealed these members likely engaged in serial acts
of "doctor shopping," and received multiple concurrent prescriptions that were
filled by numerous retail pharmacies. On average, monthly prescription
spending by high utilization patients during the three-month analysis period
(first quarter of 2004) exceeded $400, nearly seven times the monthly drug
costs of members without excessive prescription claims.
"This analysis presents a stark contrast to widely accepted views on
prescription drug abuse and prescription fraud, and may provide the clearest
picture of who these people are and how they are trying to subvert the
system," said Dr. Glen Stettin, vice president, plan management, Medco. "The
costs of abuse and fraud are staggering for the healthcare system, and present
a clear challenge that physicians, pharmacists, and benefit sponsors must
collectively address."
Among the major findings of the Medco analysis:
-- Members identified in the high utilization category filled
prescriptions at five different pharmacies and received
prescriptions from six different doctors. Some members received
prescriptions from as many as 21 different doctors.
-- Nine out of 10 prescriptions presented for dispensing by a member
who filed excessive claims were dispensed from a retail pharmacy.
-- Nine out of 10 cases of high utilization identified during the
analysis period involved excessive claims for narcotics (opioids).
Anti-anxiety medications, muscle relaxants and hypnotic agents
comprised the majority of the remainder of cases.
The Medco analysis also found that a high utilization management program
was instrumental in identifying potential abusers and restricting them to the
use of a single pharmacy, thus reducing excessive drug utilization by
32 percent among the high utilization population and decreasing benefit
sponsor drug costs by nearly 20 percent.
A recent study by The National Center on Addiction and Substance Abuse
(CASA) at Columbia University uncovered gaps in healthcare management that
open the door for manipulation of the system by patients through "doctor
shopping," forgery and deception. According to CASA, more Americans are
abusing controlled prescription drugs than cocaine, hallucinogens, inhalants
and heroin combined. The study found that 40 percent of physicians do not ask
about prescription drug abuse when taking a patient's health history, and
one-third do not regularly call or obtain records from the patient's previous
(or other treating) physician before prescribing a controlled substance.
Physicians also cited doctor shopping, patient deception of doctors and forged
and altered prescriptions as the primary mechanisms of prescription diversion.
"There is a clear need to support the clinical care team with the tools
that are necessary to help them identify patients who may be manipulating the
system," said Stettin. "High utilization review systems are one of the secret
weapons in the war on prescription drug abuse, and have a valuable place in
the arsenal against this type of behavior."
Solution to the Ills - High Utilization Management
To address the growing epidemic of prescription drug abuse and fraudulent
activity, Medco has developed clinical management systems including its high
utilization management program and RationalMed(R) Patient Safety Solutions
that identify patients attempting to fill inordinately high or excessive
quantities of prescription drugs within a given time frame.
Medco's high utilization management program reviews medications within
certain drug categories that have the potential for abuse including
tranquilizers, skeletal muscle relaxants, narcotic cough and cold,
anorexients/amphetamines, narcotic analgesics, non-narcotic analgesics,
barbiturate sedative-hypnotics, and non-barbiturate sedative hypnotics.
Alerts are triggered when:
-- Multiple prescription claims are filled by one patient within
90 days
-- Multiple doctors and multiple pharmacies are used by one patient to
obtain medications
-- Excessive accumulation of days of therapy are dispensed during a
90-day interval for one patient
Once potentially abusive patterns of prescription drug usage are
identified, physicians are notified and provided with the patient's complete
drug history, guidelines to curb abusive drug use and an option to limit the
patient to the use of a single pharmacy. Many of Medco's clients, including
several state employee benefit programs, participate in the company's high
utilization programs.
540 narcotic pills - a case study
One particular case provides an alarming view of the problem. A patient
identified by Medco's high utilization management system had received
prescriptions for the narcotic pain medication hydrocodone - a controlled
substance known to be addictive - from six different doctors and attempted to
fill them at three different pharmacies over a three-month period.
Collectively, the prescriptions amounted to 540 pills.
Once the patient was identified, Medco alerted the prescribing physicians
and dispensing pharmacists. In response to the alert, one physician contacted
by Medco replied: "I was not aware that she was getting the medications from
other doctors. I have instructed my staff that we will not be providing any
additional narcotic analgesics unless it becomes necessary."
In addition to the high utilization program results, RationalMed's
over-utilization and therapy duplication rules delivered more than 4,200
alerts to more than 37,000 physicians in 2004 related to therapy duplication
of narcotic agents. Physicians agreed to make therapy changes or stop therapy
altogether nearly 70 percent of the time they were alerted to a problem.
"Doctor shopping and filling prescriptions at multiple pharmacies are
common vehicles for those looking to subvert the system at the gross expense
of health plans and employers," said Stettin. "Fortunately there are programs
in place like our high utilization system that can identify these practices
and act on that information to prevent abuse and fraud, and save our clients
significantly on their healthcare costs."
About Medco
Medco Health Solutions, Inc. (NYSE: MHS) is a leader in managing
prescription drug benefit programs that are designed to drive down the cost of
pharmacy healthcare for private and public employers, health plans, labor
unions and government agencies of all sizes. With its technologically
advanced mail-order pharmacies and its award-winning Internet pharmacy, Medco
has been recognized for setting new industry benchmarks for pharmacy
dispensing quality. Medco serves the needs of patients with complex
conditions requiring sophisticated treatment through its specialty pharmacy
operation, which became the nation's largest with the 2005 acquisition of
Accredo Health. Medco, the highest-ranked prescription drug benefit manager
on Fortune magazine's list of "America's Most Admired Companies," is a Fortune
50 company with 2004 revenues of $35 billion. On the Net:
http://www.medco.com.
This press release contains "forward-looking statements" as that term is
defined in the Private Securities Litigation Reform Act of 1995. These
statements involve risks and uncertainties that may cause results to differ
materially from those set forth in the statements. No forward-looking
statement can be guaranteed, and actual results may differ materially from
those projected. We undertake no obligation to publicly update any forward-
looking statement, whether as a result of new information, future events, or
otherwise. Forward-looking statements in this presentation should be
evaluated together with the risks and uncertainties that affect our business,
particularly those mentioned in the Risk Factors section of the Company's
Annual Report on Form 10-K filed with the Securities and Exchange Commission.
SOURCE Medco Health Solutions, Inc.
 back to top
Related links:
http://www.medco.com
CONTACT:
Ann Smith, Medco Health Solutions, Inc.,
+1-201-269-5984, ann_smith@medco.com; or Janet Schiller or Erin
Drelick, Coyne Public Relations, +1-973-316-1665, for Medco
Health Solutions, Inc.
|
