Least Medicating Movement Going Viral

by Mike Connors, CANHR Advocate

Congressional hearings sometimes come and go with little effect, but November’s U.S. Senate Special Committee on Aging hearing on the misuse of antipsychotic drugs in nursing homes is giving a major boost to the least medicating movement. At the November 30 hearing, Senator Richard Blumenthal called overuse of antipsychotics a “form of elder abuse,” Dr. Jonathan Evans of the American Medical Directors Association recommended that use of these drugs should be “near zero” for people with dementia, and Toby Edelman of the Center for Medicare Advocacy called for an end to the epidemic use of antipsychotic drugs in nursing homes.

All signs are that federal officials are finally getting the message.

CMS Plans Campaign to Reduce Antipsychotic Drug Use

Most promising, perhaps, is the announcement by the Centers for Medicare and Medicaid Services (CMS) that it is planning a national campaign to reduce antipsychotic drug use in nursing homes and to improve dementia care. CMS’s role is critical because it enforces federal nursing home standards, oversees state agencies that inspect nursing homes, supplies information to the public on nursing home quality and controls Medicare (and to a lesser degree Medicaid) spending on these drugs. CMS is planning a free web kickoff event on March 29 to describe the purpose and elements of the campaign. We will post details about the event and the CMS campaign as they become available.

Federal Trade Commission Blocks Omnicare Merger

The Federal Trade Commission (FTC) also got into the action on January 27, 2012 by suing to block Omnicare’s hostile bid to gobble up rival long-term care pharmacy provider PharMerica. Omnicare and PharMerica dominate the long-term care pharmacy market, operating together more than 300 long-term care pharmacies in nearly every state. While we opposed the merger because of their histories of promoting use of antipsychotics in nursing homes, the FTC cited an “anticompetitive advantage” and higher prices in its press release.

“If Omnicare is allowed to purchase its biggest and only national competitor, it will diminish competition and raise health care costs – leaving taxpayers and patients to foot the bill,” said Richard Feinstein, Director of the FTC’s Bureau of Competition.

Shortly thereafter, Omnicare gave in, allowing its bid to expire, and the FDA dismissed its complaint.

Although the FTC action essentially preserves the not-so-great status quo, it is heartening that the FTC acted aggressively to keep the situation from getting worse.

Senator Grassley Urges State Medicaid Officials to Crack Down on Docs Who Over-Prescribe Antipsychotics

As reported by ProPublica on January 24, 2012, Senator Charles Grassley sent letters to Medicaid officials in 34 states, including California, asking what they are doing to stop abusive prescribing of psychoactive drugs and painkillers. His letters say psychoactive drugs are being “prescribed at astounding rates” and that the potential for prescriber fraud is “extremely high.”

His January 23, 2012 letter to California includes the following statement:

For example, two doctors who practice together in the same clinic and have the same surname, wrote a combined 2,312 prescriptions for Zyprexa in 2009 at a cost of $879, 286 to Medi-Cal. This is more than double the next prescriber and five times the amount prescribed by the tenth most prolific prescriber .…One of these same psychiatrists also wrote an astonishing 1,594 prescriptions for Seroquel – a drug that is being abused at alarming rates across the country – and another 822 prescriptions for Abilify.

Kudos to Senator Grassley for challenging these shocking practices and pushing states to crack down on Medicaid fraud involving these drugs. Similar efforts are needed to stop Medicare fraud and abuse because Medicare is paying for most of the misuse of antipsychotic drugs in long term care settings.

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