Federal regulators recently issue a warning health care providers accepting federal funding to be on the lookout for inappropriate prescriptions of a powerful antipsychotic drug commonly used in nursing homes to treat a host of disruptive behaviors. The memo comes from the Centers for Medicare and Medicaid Studies and applies to providers accepting Medicare Part D, including nursing homes and pharmaceutical distributors.
The drug in question is called Nuedexta and is commonly used to treat a rare condition marked by uncontrollable laughing and crying, called pseudobulbar affect (PBA) but is suspected to also be overprescribed for so-called “off label” uses. In the past year, several media reports have indicated that doctors at nursing homes have been overprescribing Nuedexta in order to control not only the symptoms of those struggling with dementia but also generally unruly behavior in residents without dementia.
While Neudexta’s maker, Avanir Pharmaceuticals, claims many dementia patients suffer from PBA and benefit from the drug, the company has also generated millions of dollars in annual sales in nursing homes since the drug launched in 2011. In most cases, the federal government picked up the costs for those bills when it reimbursed nursing homes through Medicare’s Part D program.
Although doctors prescribing drugs for off label conditions is not illegal in itself, the government considers making improper diagnoses for the sake of securing reimbursement from federal health care programs to be fraud. In one particular case, an Ohio doctor, who was a top prescriber of the drug, was accused of accepting kickbacks in exchange for prescribing Nuedexta and fraudulently diagnosing patients with PBA to secure Medicare coverage.
The revelations about Nuedexta are nothing new, as insurance companies and advocacy groups have been complaining to the federal government as far back as 2012 when discrepancies in prescription rates were first noticed. “I am concerned with the off label promotion of Nuedexta for diagnosis other than PBA,” stated a 2016 complaint. “Specifically they are targeting residents with Dementia with Behavioral Disturbances.”
The reports raise alarming questions about just how far some nursing homes and their doctors will go to control “problem residents” while also syphoning off vital government resources meant to help senior citizens. Hopefully, federal regulators and Congress will act quickly to curb the improper and possibly illegal behavior of large drug companies and the doctors they rely on to generate millions of dollars in revenue.