Senators Target Antipsychotic Overuse in Nursing Homes

Two prominent U.S. Senators have asked the Centers for Medicare and Medicaid Services (CMS) to investigate the use of antipsychotic drugs in nursing homes. In a letter dated August 1, Senators Charles Grassley, D-Iowa, and Herbert Kohl, D-Wisconsin, voice concern that nursing homes are over-prescribing potential risky antipsychotic drugs to control the behavior of senior patients.

Antipsychotic drugs include Clozaril, Abilify, and <"">Seroquel. Such drugs are approved to treat schizophrenia and bipolar disorder. However, they are often used often-label to treat seniors with dementia, even though such drugs carry a black box warning that elderly people treated in this way have an increased risk of death.

According to a report from MedPage Today, a study from Department of Health and Human Services Office of the Inspector General (OIG) released last May found that 14% of all nursing home residents with Medicare had claims for antipsychotics and 88% of the atypical antipsychotics prescribed off-label were for dementia.

“Nursing home residents are getting antipsychotic drugs for dementia, not psychoses,” Senator Grassley said at the time the OIG study was released. “No one seems to have a good handle on whether the patients are benefiting from these medicines or whether they’re being prescribed drugs that don’t help and might even harm them. The government needs to do a better job of protecting nursing home residents from unnecessary drugs. I’ll continue to work to hold the Medicare program and nursing homes accountable for the quality of care delivered to nursing home patients.”

In their second letter to CMS administrator Donald Berwick, MD since the release of the OIG study, Senators Kohl and Grassley request that he more closely investigate the issue of antipsychotic overuse in nursing homes more closely. In particular, they asked Berwick to investigate whether rebates pharmacy benefit managers may receive from drug companies play a role in encouraging antipsychotic overuse in long-term care facilities, MedPage Today said.

They also suggested physicians who off-label prescribe drugs bearing black warnings for seniors be required to certify that a Part D provider will cover the cost of the medication. In their letter, the Senators assert that this would reduce Medicare payments for drugs that “lack a medically-accepted indication,” MedPage Today said.

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