Medpage Today reported that companies that administer Medicare Part D drug programs for seniors cannot tell whether antipsychotics and other drugs they cover are being used for medically accepted indications, according to a new report from the Department of Health and Human Services’s Office of the Inspector General (OIG). The investigation and report were a result of substantial concerns that nursing home residents are being over-prescribed atypical antipsychotics.
An OIG report earlier this year found that 14% of all nursing home residents with Medicare had claims for antipsychotics, and 88% of the atypical antipsychotics prescribed off-label were for dementia. More than half of all elderly nursing home residents’ Medicare claims for antipsychotics were made erroneously, the OIG found.
There are eight atypical antipsychotics approved by the FDA to treat schizophrenia and/or bipolar disorder, including clozapine (Clozaril), aripiprazole (Abilify), and quetiapine (Seroquel). None of them are approved to treat dementia and must carry black box warnings that elderly people who take atypical antipsychotics have an increased risk of death, compared with those who take placebo pills for dementia.
The report found that nursing homes were being reimbursed without documentation whether a drug was used for a medically accepted indication.
Sen. Herb Kohl (D-Wis.) asked witnesses at the hearing about the new report — all of whom were government officials or aging and nursing home experts — why antipsychotics are being so widely used to control behavior in nursing homes.
One witness, Toby Edelman, an attorney with the Center for Medicare Advocacy, pointed to understaffed nursing homes; high turnover of nursing home staff who don’t have time to get to know each patient; and to off-label marketing by drug companies who illegally promote the use of antipsychotics to doctors as a treatment for their elderly patients. Edelman also pointed to a decline in the use of physical restraints in nursing homes as a reason antipsychotic use in nursing homes has increased.
Dr. Jonathan Evans pointed to another more pervasive problem leading to overuse of the drugs among the elderly: The belief among doctors that medication is the first-line therapy for treating elderly adults with behavioral issues.
"There is a firm, fixed belief among many healthcare professionals that difficult or disruptive behaviors are causes for medication and that medication is likely be beneficial for that purpose," said Evans, who is the vice president of the American Medical Directors Association. "That belief is wrong."