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Over-Prescribing of Antipsychotic Drugs: How It Happens

2015-03-03

Here’s a quote from a New York Times article published yesterday that explains how excessive drug prescribing happens:

A Chicago psychiatrist pleaded guilty last month to taking illegal kickbacks of nearly $600,000 to prescribe an antipsychotic drug for his patients. The doctor, Michael J. Reinstein, also agreed to pay $3.79 million to the federal government and the State of Illinois to settle a lawsuit asserting that he had been involved in the submission of at least 140,000 false claims to Medicare and Medicaid. Law enforcement officials said he had prescribed clozapine for thousands of older and indigent mentally ill patients at 30 nursing homes and other sites.

The lawsuit said drug companies had paid kickbacks, consulting fees and entertainment expenses for Dr. Reinstein as part of an effort to induce him to write prescriptions for clozapine.

Last March, Teva Pharmaceuticals Industries and a subsidiary, IVAX Pharmaceuticals, agreed to pay $27.6 million to settle allegations that they had violated federal and state False Claims Acts by making payments to Dr. Reinstein.

Investigators from the Government Accountability Office said in 2011 that Medicare officials were doing little to monitor the use of prescription drugs by Medicare patients. But Medicare also designates antipsychotic medications as one of six “protected classes,” meaning that drug insurance plans must cover all or substantially all drugs in that therapeutic class.

The article can be found at: http://www.nytimes.com/2015/03/02/us/psychiatric-drug-overuse-is-cited-by-federal-study.html

Why do drug insurance plans have to cover all drugs in the class of antipsychotics?  Is there evidence that all such drugs are vitally necessary in the treatment of anybody, particularly the elderly?  In fact, there is evidence for the opposite: elderly patients who receive antipsychotics have higher death rates than those who do not.

The General Accountability Office(GAO) (the one branch of government that tries to ensure our tax dollars are spent wisely) has said that Medicare officials are “doing little to monitor the use of prescription drugs by Medicare patients.”  That means that there are no controls on drug prescriptions to the segment of the population that uses the most drugs: the elderly and disabled.

Congress should listen to the GAO and force Medicare to do more to monitor and control the use of prescription drugs; tolerating the behavior of drug companies revealed by this lawsuit is criminal negligence.  The psychiatrist who admitted to receiving huge kickbacks for prescribing antipsychotics is only the tip of the iceberg.   The GAO and the Justice Department should get together and enforce some rational behavior by Medicare.  Congress should establish a department within Medicare devoted to the study of the rational use of prescription drugs.

 

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