By Jenny Westberg, June 17, 2013
How much does Oregon’s Medicaid program pay for expensive mental health drugs like Seroquel and Zyprexa?
The data obtained by Sen. Charles Grassley (R-Iowa) may not provide every answer about Oregon clinicians’ prescribing practices, but it does shine a light on previously obscured information.
Grassley, who is ranking member of the Senate Committee on Finance, wrote to Bruce Goldberg, director of the Oregon Division of Medical Assistance Programs, in 2010 and 2012, expressing concern about heavy prescribing by a subset of providers and the possibility of waste and fraud. In particular, Grassley asked about certain high-priced and often overprescribed antipsychotics, as well as common drugs of abuse that can wind up on the black market or lead to addiction and even death.
In response, Goldberg produced listings of the top 10 Medicaid prescribers of specified drugs, for 2008, 2009, 2010 and 2011.
The information covers the following second-generation “atypical” antipsychotics:
and these frequent drugs of abuse:
The top 10 prescribers for each form of each drug (brand name, generic, long-acting, etc.) were identified with their 10-digit NPI numbers, along with total number of prescriptions and total cost to Medicaid for every entry.
As a service to journalists, researchers, and others interested, the Mental Health Association of Portland went through the raw data, found names for the NPI numbers, added up the numbers for different forms of the same drug, and matched data for the same provider appearing in different places. We have entered it all on a spreadsheet on Google Drive, with several reports to show the data various ways (reports are on separate sheets you can see by clicking the tabs at the bottom of the spreadsheet).
It is important to remember that this is very specific information that applies only to the top 10 prescribers for each drug, and only for prescriptions billed to Medicaid. For example, you might see a provider with totals for two drugs. This does not necessarily mean they didn’t prescribe Drug #3. But for the third drug, the provider wasn’t in the top 10. Likewise, if a provider does not appear on the lists, it does not necessarily mean they are prescribing more conservatively; it could be that this provider does not take Medicaid patients.
Also, keep in mind that the antipsychotics have been coming off patent the past few years, so prescriptions could stay high while total dollar amounts dipped.
Finally, we did not include the data from 2008 in our spreadsheet. During that year, many prescriptions had no NPI number. Another identifier was being used – but not always, and when there was no identifier, pharmacies recorded “999999.” Since the 2008 data would not be comparable, we only worked with 2009-11.
From the data alone, it is impossible to draw conclusions; a high-volume prescriber may be overprescribing — or busy. We hope others will take these numbers and provide some context, so all of us can benefit from this store of information.
Read or download the Oregon prescriber data spreadsheet: https://docs.google.com/spreadsheet/ccc?key=0Arv37LTwMHQHdFJJdUVyUWlzcEJsdVJ6bU5sWENLSnc&usp=sharing
Correspondence and Raw Data (PDFs)
Letter from Sen. Grassley to Oregon DHS chief Bruce Goldberg 2010
Bruce Goldberg responds to Sen. Grassley 2010
Bruce Goldberg responds to Sen. Grassley 2010 with additional info
Letter from Sen. Grassley to Bruce Goldberg, asking for update 2012
Bruce Goldberg responds to Sen. Grassley 2012
DHS – Oregon Top Prescribers List 2008-2009
DHS – Oregon Top Prescribers 2010
DHS – Oregon Top Prescribers 2011