SC Limits Some Medicaid Patients To Only 1 Pharmacy

Columbia, SC—South Carolina is now requiring some Medicaid recipients who are suspected of abusing prescription drugs to get all of their prescriptions from just one pharmacy. It’s a pilot program called “Pharmacy Lock-In”.

“One person that we included in the Lock-In pilot, over a five months period, they had seen 26 different doctors and were visiting 8 different pharmacies,“ says Jeff Stensland, spokesman for the South Carolina Department of Health and Human Services (SCDHHS), which set up the program.

The patients go to so many different doctors so they can get multiple prescriptions for narcotics like OxyContin. Then they get those prescriptions filled at different pharmacies to lessen the chances of anyone noticing they’re getting so much.

“These are people who are either using it for themselves because they have an addiction problem or they’re diverting it to others on the street,“ Stensland says. “So in either case it’s not good.“

The agency started the program by identifying 48 Medicaid clients strongly suspected of abusing prescription drugs, based on an analysis of prescription data. SCDHHS then sent each of them a letter informing them they would have to choose one pharmacy from which to get all of their prescriptions.

In just eight months, the pilot program has saved taxpayers more than $321,000, Stensland says. That’s because, once these patients knew they could not go to multiple pharmacies, there was a 40 percent decrease in the total number of prescriptions used and a 43 percent decrease in the use of narcotics.

But taxpayers also saved because there was a 36 percent decrease in the number of Medicaid claims for doctor visits and a 21 percent decrease in the number of emergency room visits. Once the patients realized they couldn’t get multiple prescriptions filled, there was no need to go to multiple doctors to get those prescriptions.

West Columbia pharmacist Patrick Whiddon says the pilot program makes it a lot easier for pharmacists to notice problems. “You can cut down on duplications. You can cut down on excessive use. You can cut down on multiple prescribing habits, and it’s easier to regulate it,“ he says.

The pilot program has been so successful that DHHS will add another 200 Medicaid recipients in the next few months.