Is pharmacy, prescriber lock-in the antidote for Rx abuse?

In an effort to curb prescription drug abuse, at least one state has embraced the concept of limiting some people to a specific prescriber and pharmacy for controlled substances. And the concept is also gaining some traction nationally.

In Oklahoma, some Medicaid patients must use a designated prescriber and pharmacy to receive medications classified as controlled dangerous substances.

E-Rxs for controlled substances: The system has glitches

The patients forced into the lock-in system are those the Oklahoma Health Care Authority (OHCA) considers at risk for misusing painkillers and anti-anxiety medications.

“If they need blood pressure medicine or antibiotics, they can get that at any pharmacy from any prescriber, but if they are getting controlled substances like opiates or stimulants, that has to come from their lock-in prescriber and at their lock-in pharmacy,” Nancy Nesser, OHCA’s pharmacy director, toldNewsOk.com.

Nesser said the lock-in program is designed to combat doctor shoppers. Oklahoma has one of the highest rates of prescription drug abuse in the nation.

Nesser said about 400 Medicaid patients in Oklahoma are part of the lock-in program. They must stay in the program for two years, at which point OHCA reevaluates the enrollee.

Meanwhile, Congress is considering legislation (HR 1021, “Protecting the Integrity of Medicare Act of 2015”) that includes lock-in pharmacy provisions for Medicare beneficiaries considered at high risk of abusing prescription drugs. The National Community Pharmacists Association (NCPA) said it has serious concerns that drug plan sponsors will use the lock-in provision to steer business to pharmacies in which they have a financial interest.

“Lock-in pharmacy initiatives in state Medicaid programs virtually always include the ‘lock-in’ of both prescriber and pharmacy because a coordinated approach to patient care is essential to the success of any such program,” said NCPA CEO B. Douglas Hoey, RPh, MBA. “The committee’s proposal to require the ‘lock-in’ of both a prescriber and a pharmacy is an improvement compared to proposals that overlook prescribing. The prescription drug abuse epidemic is complex and wide-ranging in nature and at the forefront of prevention efforts must be a focus on reducing the inappropriate prescribing.”

Click here to read the letter NCPA sent lawmakers.

NCPA is advocating safeguards to such provisions that include strengthening beneficiary protections to help prevent the mandated use of pharmacies owned by or affiliated with the drug plan sponsor; clarifying exempted individuals to include patients in long-term care settings and those suffering intractable pain; and increased use of existing authorities to combat prescription drug abuse.