Inappropriate Medicare Part D Payments for Schedule II Drugs Billed as Refills. Executive Summary.

摘要

Schedule II drugs have the highest potential for abuse of any prescription drugs legally available in the United States. They include narcotics commonly used to relieve pain and stimulants. The Drug Enforcement Agency (DEA) regulates Schedule II drugs, and the Controlled Substance Act prohibits the refilling of prescriptions for them. In 2009, Medicare Part D paid $2.2 billion for Schedule II drugs. Abuse of Schedule II and other prescription drugs is a serious problem. The Centers for Disease Control and Prevention (CDC) has characterized prescription drug abuse as an epidemic. In fact, more deaths in 2007 were caused by prescription painkillers, including several Schedule II drugs, than by cocaine and heroin combined. In addition to causing public health concerns, Schedule II drugs have been at the center of several schemes to defraud the Medicare Part D program. Schemes involving Schedule II drugs include forged prescriptions and diversion through unscrupulous pharmacists, doctors, and dentists. In a recent case, two Los Angeles-based doctors were charged with health care fraud for knowingly prescribing Schedule II drugs to individuals who did not have a medical need for them. Over an 18-month period, Medicare Part D paid more than $2.7 million for the Schedule II drugs prescribed by these doctors.