The state plans to stem the overuse and illegal sale of prescription drugs it helps pay for by stopping Medicaid recipients from obtaining powerful pain relievers from multiple physicians and pharmacies.
In an attempt to end pharmacy-hopping, the state Medicaid office is making about 3,000 high users of certain drugs, including OxyContin, Xanax and Valium, go to only one pharmacy and get prescriptions for controlled substances from only one medical office. The "lock in," as the state is calling it, is expected to save the state about $2 million a year in drug costs, said Craigan Gray, the state's Medicaid director.
"The physician, the pharmacy and the patient are all under a high level of scrutiny," he said of the plan.
The anticipated savings are a fraction of the state's annual Medicaid tab of about $10.5billion. But reducing heavy drug use will also cut the cost of emergency room treatment for overdoses, he said.
"Medicaid is determined not to be the No. 1 supplier of OxyContin in the state of North Carolina," Gray said. "For people who really need it, it is available in appropriate doses for appropriate lengths of time."
The 3,000 people affected represent about 0.2 percent of North Carolina residents who use the government insurance for the poor and disabled.
Gov. Bev Perdue's office said the changes are an example of the state's move to attack Medicaid fraud and save money.
For years, the state has considered ways to reduce Medicaid prescription drug costs. The state this year limited Medicaid patients to mostly generic drugs or brand names for which it gets rebates.
In July, the state began to inform people who have a pattern of filling multiple prescriptions that they have to pick one pharmacy and one prescriber for all controlled substances. The "lock in" takes effect Oct. 4.
Prescription drug abuse is rising rapidly in the United States. The Office of National Drug Control Policy reported this year that prescription drugs were the second-most abused category of drugs, after marijuana.
Though a popular picture of a prescription drug abuser is a teenager sneaking pills out of the family medicine cabinet, the main abusers in North Carolina are middle-aged men, according to state officials.
On Tuesday, a legislative committee will discuss abuse of prescription drugs - in Medicaid and in general. The panel will consider its effects on communities and families as well as the state's role in addressing the problem.
"Prescription drug abuse is one of the biggest issues out there," said Sen. Bill Purcell, a Laurinburg Democrat and a co-chairman of the Joint Legislative Health Care Oversight Committee. "We want to see if there is something to do legislatively."
Legislators will hear about Medicaid's single-pharmacy plan at the meeting.
Pharmacists who see customers filling multiple prescriptions for controlled substances have the authority to refuse to dispense the drugs, Gray said.
"Pharmacists have a professional responsibility to monitor that," he said. "When there is a lock-in, the responsibility is heightened."
