HIV drug beneficiaries may be defrauding Medicare Part D

Almost 1,600 people who used Medicare Part D in 2012 are suspected of possibly misusing their HIV drugs or selling them on the black market, according to a new government report.

The Department of Health and Human Services Office of Inspector General (HHS OIG) released a report Wednesday saying the beneficiaries had “questionable” HIV drug use patterns.

According to the agency, the people under suspicion had either not been diagnosed with HIV, received excessive amounts of HIV drugs, received the drugs from a large number of pharmacies or received the drugs despite serious concerns about side-effects.

“These patterns may indicate that a beneficiary is receiving inappropriate drugs and diverting them for sale on the black market,” said the report. “They may also indicate that a pharmacy is billing for drugs that a beneficiary never received or that a beneficiary’s identification number was stolen.”

The agency is also concerned some people who don’t have HIV may be abusing certain antiretroviral drugs for their “intoxicating effects” when combined with painkillers.

While Medicare Part D doled out $2.8 billion for HIV drugs in 2012, the HHS OIG says the cases in question cost the system $32 million.

The report makes a number of recommendations for the Centers for Medicare and Medicaid Services to expand their oversight of how drugs are prescribed in the Medicare program including limiting patients to a number of pharmacies where they can buy their HIV drugs known as a “lock in.”

The idea has already been floating around in Congress; Reps. Gus Bilirakis (R-Fla.) and Ben Ray Luján (D-N.M.) have co-sponsored a bill titled “The Medicare Part D Patient Safety and Drug Abuse Prevention Act of 2013,” which would limit the number of pharmacies where beneficiaries who are at high risk for abuse can get their drugs.