[Congressional Record Volume 142, Number 120 (Thursday, September 5, 1996)]
[Extensions of Remarks]
[Page E1515]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 GAO REPORT SUPPORTS GOALS OF H.R. 2839

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                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, September 4, 1996

  Mr. STARK. Mr. Speaker, last December, I introduced H.R. 2839, a bill 
to require the Secretary of HHS to implement an on-line prescription 
drug information management program for Medicare beneficiaries. This 
system, known as the Medicare Medication Evaluation and Dispensing 
System [MMEDS], would provide the tools and information to 
beneficiaries and their health care providers that are needed to reduce 
instances of adverse drug interactions, over-medication, and other 
problems related to prescription drug use that harm our Nation's 
retirees and disabled.
  On June 11, 1996, the General Accounting Office issued report B-
261530 which discussed the benefits of a similar system in the Medicaid 
program. The report shows that the Medicaid program has been a clear 
success and--I would argue--supports the development of such a system 
for the entire Medicare elderly and disabled population.
  Following are portions of the GAO summary--positive findings which I 
hope will help us pass H.R. 2839 as a way to save money and lives:

       It is widely accepted in the health care community that 
     inappropriate use of prescription drugs can cause adverse 
     reactions that can lead to drug-induced illness, 
     hospitalization, even death. Such inappropriate use can also 
     be expensive for the Medicaid program. Concerned about this 
     issue, the Congress mandated that states establish 
     utilization review programs to review Medicaid prescriptions 
     before drugs are dispenses (called prospective reviews) in 
     order to prevent potential adverse medical reactions. The 
     legislation did not require that prospective screening be 
     automated. However, 43 States plus the District of Columbia 
     have implemented or plan to implement automated prospective 
     drug utilization review (PRODUR) systems. In most instances, 
     PRODUR systems are implemented concurrently with an automated 
     screening capability for Medicaid eligibility since both 
     depend on automated systems that offer real-time responses to 
     inquiries. The five States in our review have this feature.
       Automated prospective drug utilization review (PRODUR) 
     systems increased patient safety and reduced Medicaid program 
     costs in the five states whose systems we examined; all five 
     states found the systems beneficial and worthwhile. During a 
     12-month period ending June 30, 1995, these five states' 
     systems alerted pharmacists to over 6.3 million prescriptions 
     that had the potential to cause adverse medical reactions 
     from drug therapy problems including drug-drug interaction, 
     overutilization, and pregnancy conflict.\2\ Over 650,000 (10 
     percent) of these prescriptions were canceled because of the 
     potential serious risk to patients. According to state 
     officials, pharmacists reviewed and eventually filled the 
     other prescriptions on the basis of the pharmacists' 
     professional judgment and/or consultation with the recipients 
     or their physicians.
       Along with increasing patient safety, these systems also 
     reduced program costs by over $30 million, according to state 
     and contractor reports. Over $5 million of this total was 
     attributable to rejecting efforts to refill prescriptions 
     before a large portion of the earlier prescription would have 
     been consumed, potentially causing harm to the patient; the 
     remaining $25 million resulted from prescriptions that were 
     denied due to patient ineligibility. While these direct 
     benefits are significant, the major dollar savings, in all 
     likelihood--though more difficult to document--are achieved 
     through avoided hospitalization due to inappropriate drug 
     therapy. On the basis of its review of studies related to 
     drug-induced illnesses, the Food and Drug Administration 
     (FDA) indicated that 6.4 percent of hospital admissions 
     nationwide can be traced to inappropriate drug therapy; some 
     studies cite even higher rates for the elderly. Accordingly, 
     avoided hospitalization could potentially save hundreds of 
     millions of dollars annually. Savings could also accrue 
     because PRODUR systems can help identify potential fraud, 
     waste, and abuse.
       The five states in our sample screened for different 
     conditions and handled prescription cancellations 
     differently. Consequently, reported numbers and types of 
     patient safety alerts, prescription cancellations, and rates 
     of savings varied. One state, for example, did not screen for 
     pregnancy conflict. Three states automatically deny 
     prescriptions with overutilization alerts, while the other 
     two states place the responsibility with pharmacists to 
     either deny or fill the prescriptions following such alerts. 
     At present, states have no systematic way to share 
     experiences and best practices. One approach toward 
     accomplishing this would entail establishing a central 
     clearinghouse at the state or federal level to collect and 
     disseminate information. This would allow all states to make 
     more informed decisions, offering citizens the best 
     protection and states the most savings.

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