Feds Planning New Crackdown on Painkillers

Feds Planning New Crackdown on Painkillers

The U.S. government is planning a new crackdown on doctors, pharmacies and patients who over-prescribe or abuse painkillers as part of a major overhaul of the federal Medicare Advantage and Part D prescription drug programs.

bigstock-Older-man-shaking-out-pills-in-120526461-199x300The Centers for Medicare and Medicaid Services (CMS) unveiled the crackdown in a series of proposed rule changes that would give the agency sweeping new powers to prevent prescription fraud.

The changes are outlined in a 678-page report released this week. If enacted, the new regulations would take effect in 2015 and save an estimated $1.3 billion, according to the Obama administration. The public has a 60-day period to comment on the changes.

“Prescription drug abuse is a serious and growing problem nationwide. Unfortunately, the Medicare Part D prescription drug program (Part D) is not immune from the abuses associated with this nationwide epidemic,” the agency said in a statement.

As part of its fraud and abuse strategy, CMS said it would “leverage” information about Part D prescription drug claims by nearly 37 million elderly and disabled Americans by sharing the data with law enforcement agencies, and pharmacy and physician licensing boards.

“A centerpiece of this strategy that focuses on protecting beneficiaries is the identification of Part D enrollees who have potential opioid or acetaminophen overutilization issues that indicate the need to implement appropriate controls on these drugs for the identified beneficiaries. In addition, data analysis is employed to identify prescribers and pharmacies that may warrant further action to curb fraudulent or abusive activities,” CMS said.

The proposed regulations would also bring physicians under greater federal oversight by requiring that all doctors or non-physician practitioners who write prescriptions under Part D be enrolled in Medicare.

Medicare enrollment would be revoked “if CMS determines that he or she has a pattern or practice of prescribing Part D drugs that is abusive” or if a practitioner’s license or Drug Enforcement Administration (DEA) Certificate of Registration is suspended or revoked.

The proposed rule changes would also give “CMS, its antifraud contractors, and other oversight agencies” direct access to information from pharmacies that fill prescriptions under Medicare and Part D prescription drug programs. The agency said the change is needed “to provide more timely access to records” during investigations of prescription fraud and abuse.

CMS is already tracking the use of opioids and acetaminophen by Part D beneficiaries. Although the agency says its efforts have led to a “substantial reduction” in  beneficiaries with “potential opioid issues”, the actual numbers suggest the problem is small and already declining.

In 2011, over 22,000 Part D beneficiaries were identified as having potential problems with opioids or acetaminophen, according to CMS.

By 2013, that number had dropped to only 4,351 beneficiaries. Over 9 million Americans are currently prescribed opioids or acetaminophen through the Part D program – which means only 0.05% may have a problem with the drugs.

In 2013, CMS made only 60 referrals to law enforcement based on its analysis of prescription drug claims. Another 182 investigations are underway for potential referral to law enforcement agencies.

Under the proposed rule changes, CMS would be allowed to take administrative action against beneficiaries, physicians and pharmacies when a pattern or practice of abusive prescribing is identified.

National Pain Report is seeking additional information from CMS about the regulatory powers the agency is seeking.

Authored by: Pat Anson, Editor

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Zoey

To Martha whose looking for a pain clinic. Facebook has many groups that have the title “chronic pain,” “pain”, a specific diagnosis title like “rheumatoid arthritis”, or” degenerative disc disease” etc.. The people that belong to the groups are from all over and are very helpful. Search the terminology that is specific to you, just use pain and many will come up. Post the location tht you are looking for a pain clinic in or an MD that does medication management and post the question in as many different groups you can find and keep reposting until you get a few options. Hope this helps:) Take care.

Christine

Acetaminophen/paracetamol/Tylenol kills more people than all opioids for exactly that reason (no one realizes how dangerous acetaminophen overdose is because it’s OTC).

As if things aren’t already bad enough…

RPh

Sad to say it, but according to DEA agents and state regulators I’ve talked to, you’re all just a bunch of drug addicts abusing pain meds. They are so uneducated and ignorant. You’re just screwed if you have pain now. As long as that’s what they think, then pharmacists have no choice but to refuse to fill prescriptions for legitimate patients.
They should be going after people selling their pills, but instead they go after the easy targets: pharmacists and wholesalers.

Martha Nassauer

I recently moved from Long Island, to Upstate NY. I NEVER imagined how difficult it would be to find a new doctor for my pain management. I must travel 500 miles round trip to continue seeing my doctor on Long Island. This is causing me enormous stress, as I don’t really leave my house other than to see doctors, and for minimal shopping and errands. I feel as if I am holding back my young son from going out into the world, because it is he who has most of the household responsibilities. Driving back and forth is killing me. Additionally, I am surrounded by certain family members who do not understand, or care to understand, my situation. If they could only walk 30 seconds in my shoes, they would not be so judgmental and unkind. The pain in and of itself is traumatizing enough, but when there is lack of support it becomes much worse. The people who don’t understand what it is like to have pain overwhelm you every waking moment, but can attack and criticize, should really reexamine their behavior. I have been called lazy, a deadbeat, blah blah blah. To anyone reading this, know that it is already mentally harrowing for a person to live in pain…where they place enough guilt, disappointment, sadness on themselves, that they don’t need any more piled on by those who have no empathy. I just pray that those who mock may NEVER be afflicted with the same pain as those whom they make fun of. For now, does anyone know of a pain management facility that is interdisciplinary? One that does injections, physical therapy, AND prescription medication in the Oneonta, NY area? Much thanks…

Alex

Guys, the Feds just released a study showing 2000 mg a day of acetaminophen is all the liver can take before serious damage occurs. That is not picking on pain patients, it is stating what is safe, and what level can destroy our organs.

It is not a matter of keeping chronic pain patients from getting relief, it is a matter of saving patients from severe liver damage !! Please observe these limits..

Lisette Vasquez

Marijuana, thats whats next i guess. I hope its true what they say about there being all differerent kinds cuz for me personally, I get way too uncomfortable, paranoid and impaired to drive, cook for my 3.5 yr old or just function. I cant imagine my quality of life improving. Plus I have Pulmonary fibrosis and asthma so I cannot smoke it. it would have to be in pill form as cooking it is too much prep and standing hense pain.

Alice Berry

I have chronic pain and try NOT to take pain meds unless I get to a certain pont where I just can not handle the pain any longer. It does not take the pain away, only lessens it. I can also only take certain meds due to low kidney function. I hope the Drs will see who really needs the pain meds and those can get it. Also, the meds should not be re-filled if lost or stolen…it is up to the patient to keep up with their own meds. I do worry about so many people being addicted to pain meds…these meds quit working altogether after a while, so they should be changed every so often. If found you are abusing these medications, you should have to go to a place to get detoxed completely…and then re-evaluated. Please be careful o these medicines, for thy do have side effects and in the elderly, can cause even more health related problems, falls, etc

Tina

This is ridiculous. At the age of 30 I had my first back surgery, that was in 2004. Since then I have had 3 others. Thats a total of 4 FAILED back surgeries. I also suffer from spinal stenosis, degenerative disc disease and severe arthritis in my spine. And if thats not enough I was diagnose with Fibromyalgia several years ago. At the age of 40 I would love to work, have a family and a social life but due to the severe pain I suffer everyday none of that is possible. A few years ago a friend introduced me to his pain management dr and since then I’ve been able to have SOMEWHAT of a life. Every month I go to this dr, he asks whats your pain score 1-10 WITHOUT pain meds. 9-10 is ALWAYS the TRUTHFUL answer to him. Then he asks, with pain meds whats the score, I say between a 4-6 it depends on the day. ANYONE who suffers chronic daily pain knows thats a HUGE difference. Before pain management I laid in bed all day screaming and crying due to the pain. At least now I can get up, dress, go to the store or visit a friend. But because so many pharmacies are having issues with peoples insurance, I had to go to 4 different pharmacies until I found one that had my meds and No issue with my insurance. Its utter crap that us people who truly need the help are being put through this because of the low-lifes out there that abuse the system and abuse the medication! Our government needs to be concerned with the heroin and crack addicts out there selling to little kids and let our doctors, who by the way were trained in the human anatomy and how it works and illnesses abd how they affect the body do their jobs and the government (Feds) should stick to what they know, which is pretty much nothing!!!!!

I gained 50lbs because my quality of life has gone to hell, since this crap, I was able to get around and be active , now even the doctors say its not fair what the dam government is doing to the elderly !! I hate the dam government !!! leave my healthcare up to the doctors !!!

Marty

This is ridiculous. Can’t they find better things to do than to torment elderly people in pain. In the past 2 years I have gone from being an active working woman to a woman who spend a year in bed from hip and back pain so bad that I couldn’t even walk to the bathroom alone. I have at least graduated to a walker now and with the help of my pain pills can get around my apartment now. On a good day I might even be able to do a couple aisles of the store. Unless you have lived in pain you haven’t a clue. If I have to resort to going to a street drug dealer than I guess life isn’t worth living because I can’t live thru anymore pain or sleepless nights or crying until there are no tears left.

connie

This is so disturbing to those of us who have chronic pain. I support cracking down on the people who deal their prescriptions, but what is going to happen, is the people who really need pain relief won’t be able to take their meds. Awful!! I know of a person(don’t know the name) who goes to 3 pain doctors in a large metropolitan area. He takes one prescription, and sells the other two. THIS is wrong and putting those of us with real pain at risk. I expect the suicide rate to increase with the decrease of prescription drugs for pain written. I know I probably won’t be able to deal with the pain constantly. I also am not functions without something for pain. My opinion, but these people are worried about the medicare money….not the patient.

Teddi Stearns

What we need to do is find out who to contact and make ourselves heard. There are many of us with various conditions causing extreme pain. Find the contact info and then we begin a phone/letter campaign to educate the regulators.

Kristine Sease

I am a chronic pain patient. Two failed back fusion surgeries, three surgeries for a spinal coes stimulator to get me off those “horrific narcotics”. Now my body has rejected the spinal cord stim, it had to be removed. My average pain level on a GOOD day is 7. What do these KNOW IT ALL FEDS Suggest? ?

ginbug

Christine, acetaminophen is very dangerous, especially for chronic pain patients that take it daily. It destroys the liver and it does not take much at all. In fact opiates when taken correctly and for real pain, does less damage to the body than almost any drug out there and that includes even aspirin! The media is always talking about rx drugs killing 16500 people every year in the usa and that is why they say it is an epidemic. however if you compare that # to other causes of death, it is very small. Ex: otc pain drugs like tylenol & aspirin kills 44,000 per yer, 2nd hand smoke, kills 40,000, & obesity kills more than 300,000 every year in the usa alone!! Yet where is all the crack down & rules for these things? I thought this was a free country, shouldn’t we all have the right to choose what we put into our own bodies? If so one wants to get high and they are no hurting anyone other than themselves, then it is there body & can do what they want! If they want help they should be able to get it , yet this is not the way it works here. Instead we are forced to let docs do what they want to us even when it does more harm than good, just to maybe get a rx for a med that can relieve just a bit of the pain we live in 24/7 ! imagine if someone w/ high blood pressure, were denied their meds because they did not lose enough weight or allow a doc to preform a useless operation! I wonder what people would say then?

ginbug

This is all about the money and has NOTHING to do w/ protecting the patient! This will cause pain and suffering on a level that can’t even be imagined! The suicide rate will sky rocket along with the sale and abuse of street drugs! Each person is different, so what will be determined as excessive? it is already hard enough to find a good doc w/ compassion for chronic pain patients and/or pharmacies that will even fill the rx and this will make almost impossible! You will see less and less docs that will even treat those w/ chronic pain and for the few that will, it will be inadequate. I watched my mom suffer to death due to medicaid & medicare as they made her pick and choose what were the most important meds to get fill each mo. She would be put on a med that really worked and if there was a cheaper similar med they would make her doc change it. Like she had a heart med that she did well on for 6mo. even though she had tried all the other cheaper ones 1st, this one was new and it worked without driving up her sugar like all the others did; but that did not matter as they made her doc put her back on the one that drove it up the most! She ended up almost dying and was in the icu for over a week; but they still would not allow her doc to put her back on the other one even though he pleaded to them and told them that she would die w/o heart meds; but she would also die if she stayed on this med! This is only 1 example as there were many, many more things they did to her that caused huge amounts of pain and suffering and put her life in a lot of danger!! We need to all write, protest and bring awareness of the abuse that is being heaped on the poor and disabled by the medical community due to our gov’t!!! Joe public need to be educated on the real truth of what we go through instead of the 1 sided story that is being put out there about the drug war & so called pill epidemic!! They have no idea and would not believe how we are treated and abused by everyone! It’s time we show them and put them in our shoes as seeing is believing!

Diane C

The war on drugs ramps up against disabled & elderly & further threatens our privacy. Of note in article, low number of addicts in this demographic. So scary.

Chrissy

Great! So what their inadvertently going to do is push legitimate sufferers of chronic pain into getting their pain pills from street dealers as doctors begin refusing prescriptions out of fear of license revocation and criminal penalties!

Zoey

Your so right Mary. That is all I am trying to do is stay functional. My pain clinic has been lowering everyone’s pain medication under the guise of hyperplasia. I had to see a MD there who didn’t know me at all and after 20 minutes said I had hyperplasia. It’s ridiculous. I was functional before and had been stable on my prescribe dosage for many years. They have been lowering it over the last 6 months and now I can barely function. So now I’m dealing with feeling terrible about myself because I can’t be depended upon. This isn’t living anymore, it’s barely existing.

Christine W.

You need to reread you article and explain how acetaminophen (Tylenol) is considered a dangerous drug…
To date you don’t need a RX to take it. Why would you even include this in you article.

All you are doing in the piece is scaring people.

Mary o'bee

Oh great. As usual, the bad folks stealing and selling meds, do not get caught, we chronic pain sufferers get ours taken because we are on pain contracts and known. Punish the folks trying to stay functional for their families. What’s next?