Painkillers Mean Big Business For Medicare in Nevada - 8 News NOW

Painkillers Mean Big Business For Medicare in Nevada

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Top Prescribers of Oxycodone HCL in Clark County in 2011 *Physician assistant,  **Includes patients who were at least 65 as of Jan. 1, 2011 Top Prescribers of Oxycodone HCL in Clark County in 2011 *Physician assistant, **Includes patients who were at least 65 as of Jan. 1, 2011
Top Prescribers of Oxycodone HCL/Acetaminophen in Clark County in 2011 *Physician assistant,  **Includes patients who were at least 65 as of Jan. 1, 2011 Top Prescribers of Oxycodone HCL/Acetaminophen in Clark County in 2011 *Physician assistant, **Includes patients who were at least 65 as of Jan. 1, 2011
Top Prescribers of Hydrocodone/Acetaminophen in Clark County in 2011. * Physician assistant,  ** Includes patients who were at least 65 as of Jan. 1, 2011 Top Prescribers of Hydrocodone/Acetaminophen in Clark County in 2011. * Physician assistant, ** Includes patients who were at least 65 as of Jan. 1, 2011
Top Prescribers of OxyContin in Clark County in 2011 *Physician assistant,  **Includes patients who were at least 65 as of Jan. 1, 2011 Top Prescribers of OxyContin in Clark County in 2011 *Physician assistant, **Includes patients who were at least 65 as of Jan. 1, 2011

LAS VEGAS -- Statistics compiled by the nonprofit newsroom ProPublica show Nevada medical professionals prescribed more than $14.5 million worth of major pain relievers oxycodone, OxyContin and hydrocodone to Medicare patients in 2011, the latest year data is available.

The recipients of these Medicare Part D drug prescriptions included not only patients 65 and older, but also younger disabled individuals.

In a project called Prescriber Checkup, ProPublica reported that a relatively small number of physicians nationwide were responsible for a disproportionately large share of the Medicare cost absorbed by taxpayers for expensive name-brand drugs. Nevada medical professionals in 2011 wrote $390 million worth of prescriptions on behalf of Medicare patients for the 500 most popular drugs.

While much of that expense was absorbed by taxpayers, patients also shared in the cost through copayments. In many cases the retail costs were also reduced through rebates drug companies passed on to Medicare recipients.

ProPublica ranked all drugs prescribed under Medicare so the focus of the news organization wasn't only on painkillers. But because of widespread concerns about abuse of painkillers in Southern Nevada, 8 News NOW wanted to examine ProPublica data culled from sources such as the Centers for Medicare and Medicaid Services to determine the levels of such drugs prescribed under Medicare in Clark County.

The Centers for Disease Control and Prevention drew attention to the potential dangers of pain reliever abuse nationwide with a 2011 report based on 2008 data. Nevada that year had the nation's third highest drug overdose death rate, 19.6 per 100,000 residents, nearly double the national rate of 11.9 per 100,000.

Only New Mexico (27 per 100,000) and West Virginia (25.8 per 100,000) were ahead of Nevada. While those overdoses included all drugs, roughly 40 percent involved prescription opioid pain relievers.

Nevada tied for second with Tennessee with 11.8 kilograms of pain reliever sales per 100,000 residents (behind only Florida, 12.6 kilograms). The national rate was 7.1 kilograms per 100,000. Nevada also placed in a three-way tie for seventh with 5.9 percent of residents 12 and older having used pain relievers for non-medical purposes. The national average was 4.8 percent.

As 8 News NOW reported in November, the Clark County Coroner's Office considers oxycodone the deadliest drug in the county. Oxycodone contributed to 235 deaths in the county from January 2012 through November.

Among major painkillers, though, oxycodone isn't the most popular as far as Medicare prescriptions go in the county. That distinction belongs to hydrocodone/acetaminophen, which filled 265,933 prescriptions at a retail cost of more than $4.5 million in 2011. Within the county, only the cholesterol-fighting drug simvastatin accounted for more Medicare prescriptions that year.

ProPublica reported that hydrocodone/acetaminophen is used to relieve moderate to severe pain. Acetaminophen is not believed to be habit-forming when taken for a long time, according to PubMed Health, a website provided by the National Center for Biotechnology Information. But unwanted effects when taken in large doses include liver damage. Hydrocodone, though, may become habit-forming and cause mental or physical dependence if used for a lengthy period.

Popular brand names in this category include Anexsia, Ceta Plus, Co-Gesic, Dolorex Forte, Hycet, Lorcet, Lortab, Margesic-H, Maxidone, Norco, Stagesic, Vicodin and Zydone.

The leading prescriber of this combination in 2011 was Dr. Jerome Lim of SouthWest Medical Associates in Las Vegas, a doctor of osteopathic medicine who has been licensed since 2007. He wrote 1,170 Medicare prescriptions including refills, of which 804 were for patients 65 and older.

ProPublica reported that 38 percent of Lim's Medicare patients were prescribed at least one narcotic painkiller, compared to a 22 percent average for his specialty in Nevada.

Second on the list was Dr. Abhinav Sinha, a North Las Vegas internal medicine specialist who wrote 1,097 prescriptions, of which 410 were for patients 65 and older. ProPublica reported that Sinha prescribed at least one painkiller to 62 percent of his Medicare patients, compared to a statewide average of 23 percent for his specialty.

In November 2012, Sinha was accused by the Nevada State Board of Medical Examiners of nine violations of state law by failing to maintain timely and complete medical records for patients, and five separate violations that the board said amounted to malpractice. He settled last March by agreeing to a public reprimand, paying a fine and taking five hours of continuing medical education regarding both prescribing controlled substances and medical record keeping.

Placing third was Las Vegas Dr. Crispino Santos, a pain management specialist at Interventional Pain Medicine. He wrote 1,065 prescriptions, including 515 for patients 65 and older.

County medical professionals wrote 45,703 prescriptions including refills for oxycodone at a retail cost of more than $2.6 million. Popular brand names include Dazidox, Endocodone, ETH-Oxydose, Oxecta, Oxyfast, Percolone and Roxicodone.

Santos was the top prescriber of this medication, writing 984 prescriptions, including 261 for patients 65 and older. Sinha was next with 843 prescriptions, including 304 for patients 65 and older.

Third was Dr. Franco Lee, a Las Vegas pain management specialist who wrote 744 prescriptions, including 159 for patients 65 and older.

The combination oxycodone/acetaminophen resulted in 34,115 prescriptions at a retail cost of more than $2.1 million. Brand names in this category include Endocet, Magnacet, Narvox, Percocet, Perloxx, Primalev, Roxicet, Roxilox, Tylox and Xolox.

Henderson Dr. Rainer Vogel, a pain management specialist, led the way with 451 prescriptions, including 256 to patients 65 and older. Some 80 percent of his Medicare patients were prescribed at least one narcotic painkiller, slightly below the 84 percent average for his specialty in Nevada.

Santos placed second by writing 396 prescriptions, including 154 for patients 65 and older. Physician assistant Tai Pham of Las Vegas was third on the list, having written 341 prescriptions, including 169 for patients 65 and older. ProPublica reported that Pham prescribed at least one narcotic painkiller to 89 percent of his Medicare patients, compared to an average of 35 percent in Nevada for his specialty.

Medical professionals in Southern Nevada also wrote 8,757 prescriptions including refills for OxyContin at a retail cost of more than $5.1 million. OxyContin, a brand name painkiller, contains oxycodone but has an additional time-release mechanism.

Dr. Charles Tadlock, a pain management specialist at the Center For Pain Management in Las Vegas, topped the OxyContin list by writing 169 Medicare prescriptions, including 51 for patients 65 and older. ProPublica reported that 93 percent of Tadlock's Medicare patients received at least one prescription for a narcotic painkiller, compared to the 84 percent statewide average for his specialty.

Physician assistant Joshua Ostler of Las Vegas placed second on that list with 164 prescriptions, including 23 for patients 65 and older. ProPublica reported that 94 percent of Ostler's Medicare patients received at least one prescription for a narcotic painkiller, compared to the 34 percent average in Nevada for his specialty.

Another Las Vegas physician assistant, Gerald Jones, placed third by writing 143 prescriptions, including 34 for patients 65 and older. According to ProPublica, 97 percent of his Medicare patients received at least one prescription for a narcotic painkiller.

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