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TennCare narcotic spending is on the rise

12:02 PM, Jan 30, 2012   |    comments
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By Nate Rau The Tennessean

At the same time state lawmakers, law enforcement agencies and other officials have been working to address Tennessee's pain pill epidemic, TennCare spending on narcotic medications such as Lortab and Vicodin has been on a steady increase since 2007.

The state's Medicaid program, which provides health care to uninsured Tennesseans, saw spending on narcotic prescriptions increase 48 percent to nearly $49 million between 2007 and 2011.

The agency, in an effort to curb the illegal reselling of prescription medication, has implemented an array of safeguards to combat patients who shop for doctors who will write them prescriptions.

Despite those measures, the bill for controlled substances continues to grow. Law enforcement agents, such as Metro Nashville Detective Michael Donaldson, say abusers have figured out ways to get TennCare to fund their addiction habit or drug ring.

"With the advent of TennCare, and the state trying to assist people who actually need health care, users have been able to abuse the system as well as get TennCare to pay for their synthetic drugs and fuel their addiction on taxpayer dollars," Donaldson said. "That's a common problem across the country."

State Sen. Ken Yager, R-Harriman, has led the charge to regulate pain clinics, which are medical clinics designed to treat people who have severe or chronic pain.

While pain has become a legitimate problem in the country, with 116 million people suffering from its effects according to a recent study, abuse of prescription drugs is also on the rise.

In response, Yager sponsored legislation last year requiring pain clinics to register with the state; outlawing cash payments, which were the calling card of so-called pill mills; and requiring doctors to be present at the clinic at least 20 percent of the time.

Yager said he was aware of TennCare's role in sometimes paying for patients with addiction problems to access the drugs. He said he believed the issue should be taken up in the Senate's Fiscal Review Committee, of which he is a member.

According to the Tennessee Drug Task Force, 56 percent of patients who received an opioid prescription had already filled a prescription for another controlled substance within the previous 30 days.

U.S. Sen. Charles Grassley, R-Iowa, sent letters to 33 states, including Tennessee, last week demanding answers for how they plan to deal with doctors who prescribe copious amounts of pain killers and other controlled substances. So far, states have been reluctant to disclose the names of those who prescribe large amounts of controlled substances to Medicaid patients for fear it would inaccurately paint the doctors in a bad light.

Restrictions in place

TennCare officials say they are aware of the problem of prescription pain pill abuse in Tennessee, which has some of the highest rates of drug overdoses and prescriptions-dispensed in the country.To address the issue, TennCare has implemented a slew of safeguards and restrictions to limit the proliferation of controlled substances.

A program called lock-ins, which forces a TennCare patient to have prescriptions filled at a specific pharmacy, has seen recent success, according to data reviewed by the agency.

Other controls put a cap on the number of pills that can be dispensed for each doctor's visit and prevent refills before 85 percent of a prescription has been used.

The most successful measure is the lock-in, which TennCare Pharmacy Director Nicole Woods said brings more scrutiny from doctors and pharmacists to patients who have a history of seeking pain pills. Once a patient has been identified by the program as a frequent user of such medicine, TennCare requires the patient to have prescriptions filled at a specific pharmacy.

Last year, 3,299 patients were placed on the lock-in program. TennCare conducted a review of its lock-in program during the fourth quarter of 2010 and found it reduced spending on controlled substance medication by 31 percent compared with six months earlier.

Doctors monitored

In an effort to monitor frequent prescribers of controlled substance medication, TennCare also runs quarterly reports to identify the top 100 prescribers in terms of volume and percentage. Although TennCare doesn't take action against the health-care providers, Woods said the agency has noticed that prescribing habits change once a provider is notified he or she has been placed on the list.

Despite TennCare's efforts to stop abuse and fraud, spending on narcotics and the volume of narcotic claims have continued to increase.

In 2011, TennCare spent $49 million on controlled substances for its patients. In 2007, the agency spent $33 million. Last year, there were 1.28 million claims for narcotic prescriptions. In 2007, there were 1.03 million claims.

Lortab, which is a combination of hydrocodone and acetaminophen, is by far the most frequently prescribed controlled substance, according to TennCare data. In 2011, TennCare approved 707,000 claims for the drug totaling $6.8 million.

Yager said federal regulations may prevent the legislature from passing laws to restrict TennCare payouts to managed-care organizations for pain medication. But Yager said he planned to use his bully pulpit to bring the issue to the public.

"I have been discussing with staff how we can get a handle on that, because TennCare is paying for this," Yager said. "If I don't get legislation, I'm going to raise the issue in Fiscal Review."

Contact Nate Rau at615-259-8094 or nrau@tennessean.com. Follow him on Twitter @tnnaterau.

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