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2.3 Million Pills Off the Streets, $5.2 Million Saved by Narcotics Lock-in

New analysis shows program saves N.C. Medicaid spending and prevents abuse by limiting to a single pharmacy and physician

For release: Immediate    May 14, 2012
Contact: Brad Deen (919) 855-4840

RALEIGH — A recent analysis of a North Carolina Department of Health and Human Services (DHHS) program for chronic pain patients on Medicaid shows $5.2 million saved in the first year, and 2.3 million fewer pain pills were prescribed to patients in only three months.

The numbers are significant because Medicaid recipients who struggle with pain often seek multiple prescriptions, from multiple doctors, leading to dramatically higher costs and the potential for abuse and overuse. “Doctor-shopping” for narcotics can lead to addiction, overdose and pills being resold on the street.

Almost 2,500 North Carolina Medicaid recipients are currently enrolled in the DHHS “Lock-in” program for narcotics and controlled substances. Part of Gov. Bev Perdue’s efforts to reduce fraud, waste and abuse in state Medicaid, the lock-in program launched in October 2010. New technology identifies Medicaid recipients with multiple prescriptions for opiate pain relievers or sedative/anti-anxiety medicines. DHHS “locks in” those recipients to using a single physician and pharmacy.

Locking patients in to one doctor and one pharmacy ensures they receive the medications and care they truly need while providing a new level of oversight that can ferret out abuse or overuse.

“In these difficult financial times, we are searching for every way possible to save money for a Medicaid system that is adding people exponentially,” said DHHS Acting Secretary Al Delia. “At the same time, we are trying to maintain an adequate level of care and services for our neediest citizens. The beauty of the Lock-in program is that it accomplishes both significant savings and continued care. It’s a win-win.”

A recent analysis of first year data shows that locked-in recipients saved Medicaid more than $800,000 in reduced pharmacy costs alone. And because locked-in Medicaid patients were restricted from “doctor-shopping” for narcotics, they made fewer hospital, emergency room and dental visits and underwent fewer radiology scans and lab tests. Those additional savings were estimated at more than $4.4 million, for a total first-year savings of more than $5.2 million.

Comparing the three months before lock-in dates to three months afterward, Medicaid officials also found that recipients consumed 2.3 million fewer pills, or about 1,000 fewer pills apiece. N.C. Medicaid likely reduced the supply of controlled substances by millions more pills since the program was launched in October 2010.

Here are examples of patients who reduced costs significantly during the first two months after they were locked-in, compared to the two months prior:

A man from the Fayetteville area received prescriptions for nine narcotic pain relievers and two tranquilizer/anxiety medicines, which he obtained from nine separate physicians and filled at four pharmacies. He visited hospital emergency rooms five times, medical offices 14 times and had 15 radiologic scans.
Cost to state Medicaid for two months before lock-in: $39,061
Cost for two months after lock-in: $3,374
Percentage drop: 91%
Health benefits: His chronic shoulder and back pain from an old injury was managed, and he received help for health and psychological issues.

A woman from the Wilmington area obtained eight prescriptions for narcotics from four physicians, which she filled at four pharmacies. She discovered she was pregnant while visiting two hospital emergency rooms, four medical offices and receiving three radiologic scans.
Cost to state Medicaid for two months before lock-in: $13,181
Cost for two months after lock-in: $207
Percentage drop: 98%
Health benefits: She received vital prenatal care during her pregnancy and pain management for chronic back and knee issues.

A woman from the Triangle area visited seven doctors, obtaining prescriptions for seven opiate pain relievers and nine tranquilizer/anxiety medicines. She underwent four radiologic scans, made eight visits to a hospital emergency room (arriving by ambulance twice) and made nine visits to other medical offices.
Cost to state Medicaid for two months before lock-in: $24,722
Cost for two months after lock-in: $15,187
Percentage drop: 39%
Health benefits: Her health and psychological issues are being better monitored and controlled.

A man from the Charlotte area obtained seven narcotics and two tranquilizer/anxiety medicines from five physicians. He underwent four radiologic scans, made seven medical office visits and one to an ER.
Cost to state Medicaid for two months before lock-in: $27,976
Cost for two months after lock-in: less than $8,925
Percentage drop: 68%
Health benefits: His back pain and other chronic health issues are now better managed.

A woman from the Asheville area obtained eight narcotics prescriptions from four physicians, which she filled at three pharmacies. She received six radiologic scans, made four medical office visits and one to an ER.
Cost to state Medicaid for two months before lock-in: $12,598
Cost for two months after lock-in: $688
Percentage drop: 95%
Health benefits: better management of her chronic back pain.

A woman from the Triad area obtained prescriptions for nine narcotic and two tranquilizer/anxiety medicines from four physicians, filling them at three pharmacies. She underwent six radiologic scans and visited five medical offices and an ER.
Cost to state Medicaid for two months before lock-in: $18,650
Cost for two months after lock-in: $1,129
Percentage drop: 94%
Health benefits: Her chronic back pain and foot pain – plus other health and psychological issues – are managed and monitored.

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