"Lock-In" Program Could Solve Medicare Drug Fraud: NCPA

Limiting drug-abusing patients to one doctor and one pharmacy for pain medication prescriptions could be the solution to Medicare drug abuse and some forms of fraud, according to a new report from National Center for Policy Analysis Senior Fellow Devon Herrick.

“When Congress passed the Medicare Part D drug program, it inadvertently created a license to steal,” says Herrick.  

Forty-six state Medicaid programs have successfully instituted “Lock-In” plans. These programs allow drug plans to restrict an individual who has demonstrated questionable drug-seeking behavior to using just one doctor and/or pharmacy for particular drugs, generating cost savings and reducing narcotic drug abuse.

“Prescription drug abuse through Medicare drug fraud drives up seniors’ premiums and hiking costs for taxpayers and the health plans that administer seniors’ drugs benefits,” says Herrick.

Over 16,000 people die each year from abusing prescription pain relievers. For every one prescription drug death, there are:

  • 10 people admitted for prescription drug abuse treatment,

  • 32 prescription drug-related emergency room visits,

  • 130 people chronically abusing opioid pain relievers, and

  • 825 nonmedical users of opioids. 

All told, drug diversion costs taxpayers, insurers and employers more than $75 billion annually, 1.2 million emergency room visits per year, and requires countless unnecessary office visits, tests and procedures. Implementing a “Lock-In” program as part of Medicare Part D could curb fraud and narcotic drug use across the nation.

“A bipartisan proposal in Congress would allow drug plan managers to block those who profit by stealing drugs from Medicare,” says Herrick.  “While most seniors’ benefits wouldn’t be affected, ‘Lock-In’ programs would limit the ability of potential abusers to acquire narcotics for personal abuse or to resell to addicts on the black market.”

Medicare Drug Plans Need the Tools to Fight Fraud