Report on Medicare Cites Prescription Drug Abuse

To the Editor:

In an article on October 3, Robert Pear reported that congressional investigators had evidence of Medicare “subsidizing drug abuse.” 170,000 Medicare beneficiaries had received prescriptions from 5 or more practitioners for any of 14 types of frequently abused drugs. The investigators recommended “limiting patients who abuse...to one prescriber,” but Medicare officials, reluctant to limit accessibility of care, proposed improving the coordination of care between insurers.

Although that is a viable alternative, the appropriate challenge, in my opinion, is using health policy as a boundary between accessibility and abuse, or, liberty and anarchy. If the investigators' definition of drug abuse is reasonable, why not restrict prescriptions only with regard to that list of frequently abused drugs? Why not cap prescriptions from that list to 1 or 2 per beneficiary instead of capping all prescriptions? This policy would be a simpler and easier solution that values accessibility while guarding against abuse.

Sincerely,
Steven Chang