Number of Iowa patients 'locked-in' to single drug sources skyrockets

System intended to stop abuse of prescriptions drugs among Iowa Medicaid patients

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The number of Iowa Medicaid recipients “locked-in” to using one doctor, one pharmacy and one hospital to prevent prescription drug abuse has increased sevenfold from 200 in 2010 to 1,430 in January.

The jump came after Iowa Medicaid started screening patients not for just doctor-filled prescriptions, but for non-emergency visits to hospital emergency rooms.

“If someone is prescription shopping, they will seek out the ER for additional medications,” said Kelly Williams, clinical operations manager for Iowa Medicaid’s member services.

By locking in more patients, the state saved $14.8 million from July 2010 through September 2012 in the cost of drugs and doctors’ visits, said Roger Munns, spokesman for the Iowa Department of Human Services. Medicaid reimburses only designated providers.

Prescription painkillers caused 62 deaths in Iowa in 2011, a dramatic increase from four deaths in 2000, the Iowa Department of Public Health reported. Prescription abuse treatment admissions in Iowa more than quadrupled from 187 in 1999 to 878 in 2009.

High-profile overdoses, such as the 2010 death of Paul Gray, a Des Moines musician and founder of well-known metal band Slipknot, have raised awareness of painkiller addiction.

Prescription monitoring

Iowa’s Prescription Monitoring Program, launched in March 2009, is a database of all the people prescribed Schedule II, III and IV drugs in Iowa over the past four years. Doctors and other prescribers can search the database to see if their patients have prescriptions from other providers.

The goal is to prevent addicts from amassing dangerous amounts and combinations of prescription drugs.

“We physicians love the prescription drug database,” said Dr. Robert Lee, a family medicine doctor in Johnston and president of the Iowa Medical Society, which represents nearly 5,300 Iowa doctors.

And yet, only one-quarter of Iowa doctors and prescribers are registered to use the database, which includes more than 4.2 million prescriptions annually.

Gary Grabe, a pharmacist at Medicap Pharmacy, 2030 Sixth St. SW, Cedar Rapids, said he has used the PMP, but not often.

“As small of a pharmacy as we are, we know everyone,” he said.

Legislative action

The Medical Society was among groups to weigh in on three bills in the Iowa Legislature this year dealing with the PMP.

One proposal, Senate Study Bill 1015, would have required prescribers to use the database if they believed a patient might be abusing drugs. The bill, which died in subcommittee, would have protected doctors from liability from damages only if they acted reasonably and in good faith. Current law says doctors do not have a duty to use the database.

Another bill that failed to gain traction at the Statehouse would have allowed the Iowa Board of Pharmacy to sign agreements with other states to share PMP information. Doctors in border cities like Dubuque, Davenport and Council Bluffs wanted this change so they could see prescription records from neighboring states, said Terry Witkowski, Pharmacy Board executive officer.

The only PMP proposal still alive in the Legislature is House File 558, which would require the Iowa Department of Human Services to share with the Pharmacy Board the names of people added to the Medicaid lock-in list so that information could be included in the PMP.

The Medical Society is concerned the PMP — which has more detailed records than the lock-in list — would be increasingly used by law enforcement agencies for criminal prosecution, Lee said.

“More information is good,” Lee said “But I’m not sure it’s going to give us more information. We don’t want this to turn into a law enforcement tool.”

House File 558 would not change current law requiring law enforcement to have probable cause to use the PMP, said Dale Woolery, associate director of the Governor’s Office of Drug Control Policy.


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