HHS Identifies Issues in Use of Antipsychotic Drugs in Nursing Homes
Almost one in seven Medicare beneficiaries in nursing homes -- many of whom have dementia --Â is given powerful atypical antipsychotic drugs for off-label uses despite an increased risk of death associated with the medications, a recent government audit found, the New York Times reports.
The drugs include Risperdal, Zyprexa, Seroquel, Abilify and Geodon.
Key Findings of Audit
Federal rules require that any drugs paid for by the government must be approved by either government regulators or one of three independent drug usage encyclopedias. According to the audit, 51% of the 1.4 million claims studied over a sixth-month period in 2007 did not meet these standards and were paid for improperly (Harris, New York Times, 5/9).
Auditors determined that the erroneous claims cost the program $116 million. In addition, 83% of the drug claims were for off-label uses, according to the audit (Barr, Modern Healthcare, 5/9). Furthermore, 88% of the antipsychotics were given to patients with dementia, despite a higher risk of death for such patients, auditors found.
HHS Inspector General Daniel Levinson said some drugmakers illegally marketed their drugs for off-label uses, putting "profits before safety." CMS noted that some of the prescriptions likely resulted from kickbacks paid by drugmakers to nursing homes.
According to Levinson, the federal government should collect information on diagnoses of each Medicare beneficiary so that it adequately can assess the appropriateness of the drugs prescribed. However, the Times reports that physician groups and lawmakers might object to the strategy because of the potential for increased government oversight (New York Times, 5/9).
The inspector general also recommended that CMS:
- Examine the efficacy of survey and certification processes to prevent unnecessary antipsychotic drug use in nursing homes;
- Consider alternative methods to ensure compliance with federal standards regarding unnecessary drug use in nursing homes; and
- Take action against erroneous payments found by auditors.
CMS agreed with all recommendations except for collecting more information to achieve better coverage and reimbursement determinations, saying that a diagnosis is not required for billing or prescriptions (Modern Healthcare, 5/9).
Sen. Chuck Grassley (R-Iowa), who requested the audit, said, "These results are alarming," adding, "Medicare officials need to pay attention."
Meanwhile, Daniel Carlat, editor in chief of the Carlat Psychiatry Report, said physicians have few options outside of prescribing antipsychotics. He added, "Doctors want to maximize quality of life by treating the patient's agitation even if that means the patient will die a bit sooner" (New York Times, 5/9).