A program to identify fraud in the rolls of one of the country's largest prescription-benefit managers has yielded a profile of baby boomers who might be bilking the healthcare system by using multiple doctors and pharmacies to obtain powerful narcotics, the study manager said.
Glen Stettin, M.D., conducted the study for Medco Health Solutions, a Franklin Lakes, N.J.-based company that processes prescription claims for more than 60 million Americans. Researchers looked at 400,000 prescription claims and identified 170 patients who filed more than 1,000 prescription claims from January to March 2004. Half were ages 40 to 49; 8% were in their 30s; and 13% were in their 20s. "The biggest surprise was the age range," Stettin said. "We might have thought it was mostly young people."
The prescription bill for the 170 patients averaged $404, or nearly seven times the average monthly drug cost of other members.
Stettin said the analysis provided a snapshot of possible prescription abusers, and patients' physicians were contacted about possible overuse or abuse of controlled substances. About 90% of the prescriptions filled were for powerful narcotics.