oversight

Prescribed Drugs Provided to Recipients of Old-Age Assistance in Nursing Homes Under the Medicaid Program in Illinois

Published by the Government Accountability Office on 1971-09-10.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                                                                OF   TtiE       UP-i&D
                                                 WA!34rNGTON.    O.C.       20548




              B-164031 (3)
                                                                                         lllllllllllllllllllllllllllllllllll
                                                                                                LM095524

    f ,
i’            Dear >i’r . Chairman :

                      Enclosed      are listings        of prescribed        drug,s provided,+
              recinients,o,f.
               L___-_----          .ol,d:a.ge -.e__-
                                                 assistan~‘-rn_~;lrsing~
                                                  _+e-.z.,w-,a.
                                                           -- .-c‘_~--*“~_i_~..   homes under the
                                                                            _.- _._I.^
              bgdicaid       program in Illinois.             This information         was obtained
                             to your request         of July. 22, 1971.

                       The information       was furnished      to us by officials        of the
          \
              Illinois     Department      of Public    Aid in the form of computer              ~~r”‘l
      /       printouts      listing    purchases     by drug name, number of prescrip-
              tions J and amount paid during             the first     month of each quarter
              of calendar        year 1970.     !qith the assistance         of a registered
              pharmacist       on our staff,      we grouped these drugs into 25 cate-
              gories     of drugs.      The categories       which we used are those con-
              tained     in the American       Hospital     Formulary    Service    published
              by the American         Society   of Hospital       Pharmacists.

                     As shown on schedule           I, Central   Nervous System drugs--
              c-which include    tranquilizers--represent           about 35 percent       of
              all amounts     paid for drugs on behalf            of nursing     home patients
              Curing these months.            On schedules     II through      V xe have iden-
              tif ied the specific         types of drugs which account           for the ma-
              jority    of the purchases         under the Central      iu’ervous System
              category.
I                                                                Q
                     Schedule VI consists     of selected      statistical      information
              on the hledicaid  and intermediate-care          programs      in Illinois    for
              1970 and schedule    VII is a general       definition       of the drug cat-
              egories   used in schedule   I.

                       In accordance   with your request    of July 22 and subse-
              quent discussions       with your office,    similiar  information    is
              being obtained       in Chio and New Jersey;     when completed    we will
              furnish     you a report    on the rcsr:lts  of our work in all three
              Statfss.
                                                                    :
‘       .




            ,
    L




                B-164031 (3)



                       We plan to xake no further      distribution                   cf this   report
                unless    copies are specifically    requested      and               then we shall
                make distribution.only       after your agreement                    has been obtained
                or public     announcement   has been made by you                    concerning    the
                contents    of the report.

                                                              Sincerely     yours,




                                                          Comptroller   General
                                             i!isi!!g     of the United   States
            Enclosures-7


            The Honorable      Frank E. Moss
            Chairman,     Subcommittee  on
              Long-Term     Care                                !       *
            Special   Committee on Aging                $“”         ”
            United   States   Senate




                                                         2
                                                                               SCHEDULEI

                       ILLINOIS MEDICAID DRUGPROGRAM

          NUMBEROF PRESCRIPTIONSAND AMOUNTPAID FOR DRUGS
             PROVIDEDTO RECIPIENTS OF OLD-AGE ASSISTANCE
                        IN NURSINGHOMESFOR
                 JANUAR;, APRIL, JULY, AND OCTOBER1970

                                   A3 t                         Prescriptions
                Category           u;,                     Number          Amount
                                    T,p
                                     -b\
Antihistamine      Drugs                %                - 6,716          $    21,328.43
Anti-Infective      Agents               5%                20,503             103,455.06
Antineoplastic      -Agents                                      19                 73.68
Aotonomic Drugs                            % ,i\           11,045              44,794.87
Blood Derivatives                              %               -
Blood Formulation       and Coagulation          $f?        4,430               9,623.40
Cardiovascular      D-rugs                        G        26,689              81,836.27
Central Nervous System Dpugsl                        $$,   85,234             407,101.31
Diagnostic     Agents                                          146                 228.34
Electrolytic,      Caloric,   and  Water    Balance        24,636              96,896.38
Enzymes                                                        302              2,288.26
Expectorants      and Cough Preparations                    3,884               8,842.61
Eye, Ear, Nose and Throat Preparations                         761              1,572.71
Gastrointestinal       Drugs                               32,650             108,458.43
Gold Compounds
Heavy Metal Antagonists
Hormones and Synthetic         Substitutes                 13,852              62,212.44
Local Anesthetics
Oxytocics
Radioactive      Agents
Serums, Toxoids and Vaccines                                3,429              10,0;6.74
Skin and Mucous Membrane Preparations                       7,167              24,794,98
Spasmolytic Agents                                          3,228              10,398.80
Vitamins                                                   29,929              84,984.09
Unclassified      Therapeutic    Agents                        109                 638.65
Other Unclassified        Drugs2                           19,104              85,774.24
      Total    '                                          293,833         $1,165,359.69
lThis category,   which includes tranquilizers,     represents    about   35 percent   of all
  amounts paid for drugs on behalf of nursing      home patients.

‘Includes   drugs purchased under national    formularies    such as the National   Fonnu-
  lary and U.S. Fharmacopeia;   compounded prescriptions;      specially approved drugs,
  and medical suppiies   such as cotton,   gauze, s,.*ringes and hypodermic   needles.
                                                    SCHEDULEII


                ILLINOIS MEDICAID DRUGPROGRAM


          NUMBEROF PRESCRIPTIONSAND AMOUNTPAID
                FOR CENTRALNERVOUSSYSTEMDRUGS
                PROVIDEDTO RECIPIENTS OF OLD-AGE
                ASSISTANCE IN NURSINGHOMESFOR
          JANUARY, APRIL, JULY, AND OCTOBER1970


                                            PrescriDtions
                                          Number      ATnount

GENERALANESTHETICS

ANALGESICSAND ANTIPYRETICS                23,666 $X4,943.22

IWRCOTIC ANTAGONISTS
ANTIcoNvuLsANTs                            2,151       5,554.54
PSYCHOTHERAPEUTIC  AGENTS:
   Antidepressants                         3,456     22,496.69
   Tranquilizers                          32,153    207,015.48
   Other Psychotherapeutic    Agents          186     1,367.54
                                                                  I
RESPIRATORYAND CEREBRALSTIMULANTS          1,615       6,721.23
SEDATIVESAND HYPNOTICS                    22,007     49,002.61
        Total                             --85,234 $407,101.31
                                                    =
NUiE:
    CornSid
    Cmipazine
    Quagesic                                    323
   Fluephenazi                               1,179        $ 1,ml.oo
   Haldol      ne Dihydrochlori                189             51313.91
   Hydroxyzine                    !de           182
                                                               19423.81
  Libras                                        258           lJ57.57
  Librim                                    1,321             2J78.01
  Mellaril                                     246          109384.23
  Meprobamate                              3,265             lJ77.79
 Sera                                      6,854           2L351.37
 Sparine                                   1,738           53,526,51
 Stelazine                                   227            7,346.58
 Thorazine                                2,164             1,542.32
 ~rancopal                               LlOO             15,006.OO
Trilafon                                10,146             8,059.72
Valium                                        19         55324.11
Vesprin                                     8%               115.28
                                        1,901             69038.73
   Total                                  i47            13,270.28

                                    J&l53
                                                      $207,015.48
                                                    SWEDULE IV

                 ILLINOIS MEDICAID DRUGPROGRAM

            NUMBEROF PRESCRIPTIONSAK-DAMOWT PAID

                 FOR ANALGESICSAND ANTIPYRETICS

         PROVIDEDTO RECIPIENTS OF OLD-AGE ASSISTANCE

                       IN NURSINGHOMESFOR

            JANUARY, APRIL, JULY, AND OCTOBER1970

                                          Prescrintions
                                       Number           Amount
MM:
      Acetaminophen                        944      $    29687.44
      Analgesic balm                       105              111.94
      A.P.C.                               291             314.98
      Aspirin                              237              279.28
      Aspirin,    buffered                 539              797.14
      Aspirin,    enteric coated        2,276            6,449.56
      Butazolidin                          636           3,802.40
      Codeine with aspirin,
         phenacetin and caffeine        1,104            3,079.14
      Codeine phosphate                     26               68.73
      Colchicine                            53              138.42
      Crystoids                              1                1.25
      Darvon                            1,790            9,087.60
      Darvon compound                  10,524           59,491.90
      Darvon with A.S.A.                   341           2J25.43
      Demerol HCL                          134              445.94
      Dilaudid XL                            9               19.44
      Fiorinal                             236              709.36
      Indocin                           2,126           16,636.09
      Leritine                               5               16.42
      Methadome #CL                          6               16.26
      Morphine sulfate                       9               28.19
      Pabalate         s                   411           1,58X14
      Pabalate--sodium     free            a44           3,579.33
      Percodan                              72              278.86
      Sodim salicylate                     637           1,620.97
      Talwin                               310           1,572.Ol

               Total                   23,666       $114,943.22
                                   .
                                                          SCHEDULEV

                  ILLINOIS MEDICAID DRUGPROGRAM

          NUKBEROF PRESCRIPTIONSAND AKWNT.PAID
            FOR SEDATIVES AND HYPNOTICSPROVIDED
                TO RECIPIENTS OF OLD-AGE ASSISTANCE

                       IN NURSINGHOKESFOR
          JANUABY, APRIL, JULY, AND-OCTOBER1970

                                          Prescriptions
                                     Number                   amount
MANE:
   Amobarbital                           277 _            $    545.53
   Amobarbital   sodi*a                  325                   711.99
   Butabarbital   sodium              1,306                 3,157.47
   Chloral hydrate                    6,141                15,294.31
   Doriden                            2,964                 8,419&O
   Bentobarbital   sodium             2,187                 3,643.83
 . Phenobarbital                      4,043                 6,579.52
   Placidyl                           1,932                 5,808.53
   Secobarbital   sodium              2,832                 4,841.83
        Total                        22,007               $49,002.61
.    *.

          .                                                           SCHEDULEVI
    -,         -

                                ILLINOIS MEDICAID DRUGPROGRAM


                              SEJECTEDSTATISTICAL INFOPIMATION

                         ON ILLINOIS MEDICAID AND INTERMEDIATE-CARE

                                PROGRAMS
                                       FOR CALENDARYF4R 1970

              MEDICAID PROGRAM:
                 Started                                              January      1966
                 1970 expenditures:
                      Amount (millions)                                 $200.6
                      Federal share (millions)                          $100.3
              DRUGS:
                 1970 expenditures:
                     Amount (millions)                                  $ 22.2
                     Federal share (millions)                           $ 11.1
                     Percent of total Medicaid
                       expenditures                                         11.1
              NURSINGHOMXCARE:
                 Skilled nursing care:
                       1970 expenditures:
                           Amount (millions)                            $    5.3
                           Federal share (millions)                     $    2.7
                           Percent of total
                             &dicaid     expenditures                        2.7
                           Patient days of care
                             paid for                                       598,349
                   Intermediate     nursing care: 1
                        1970 expenditures:
                             Amount (millions)                          $ 62.6
                             Federal share (millions)                   $ 31.3
                             Patient days of care
                                paid for                                7,773,530
              1Provided to eligible       persons not in need of skilled  nursing
               care but in need of more intensive       care than that provided
               in residential   facilities.
                                                                                                     SCHEDULE              VI I


                          GENERAL          DEFIKITION          OF DRUG CATEGORIES


-Antihistamine              Drugs--Products                used to alleviate                   the    symptoms              of
          hayfever,          allergy,       and         the common cold.

Anti-Infective                  Agents--       Products          used    in     the      treatment         of    bac-
         terial           and    viral       diseases.

Antineoplastic                  Agents--Products                 used    in     the      treatment         of
        cancer        .

Autonomic       Drugs--Products        whose primary       effect     is on the ner-
       vous system         and includes       drugs used to treat          abnormali-
       ties     in smooth       muscle    tone and certain        abnormal     eye con-
       ditions.
                                        ..
Blood      Derivatives             --Products           used      in    blood         replacement.

Blood      Formulation    and Coagulation--Products                               used to enhance
         formation     of blood       cell products                        and components,     includ-
         ing the treatment          of anemia    and                     the treatment     and preven-
         tion    of blood   clotting.

Cardiovascular                  Drugs--Products                used to treat              abnormal       blood
       pressure,                heart     congestion,             and cardiac             insufficiency.

Central--Drugs--Products                                                    whose         primary         effect
         is on the brain                    and are       used     to    excite,          sedate,         tranquil-
         ize,    or relieve                 pain.

Diagnostic       Agents --Products                      used      to    diagnose          diseases         and        in
       laboratory      analysis.

Electrolytic,            Caloric,       and Water    Balance--Products           used                           to re-
         store      water     baiance      of body fluids.        Also,      products                             are
         used     to help       eliminate     abnormal     water    retention         in                        tis-
         sues.

Enzymes - -Products        derived      from    naturally       occurring      substances
      and generally         used to expedite             or retard      a natural     body
      process.       Frequently,          these    products       are also     used to
      treat    undesirable         blood     coagulation.

Expectorants      and Cough                    Preparations--Products                       used     to    allevi-
        ate coughs   and to                    break     up excessive                 sputum.
            .       ”




I   .
        .
                ,       *
                                                                                                                        SCHEDULE              VII

        \* ’                Eqe,    Ear,      Kose,    and Throat    Preparations--Anti-infectives,
                                    anti-inflanmatories,           and pain       reducers        used                     in      treat-
                                    ment of eye,          ear, nose,    or throat         disorders.

                            IGastlointestinal
                            ---                            Drugs --Drugs    used            to    treat          hyper-acidity,
                                     diarrhea,          nausea,    and vomiting.

                            Gold      Compounds--Products             containing          gold            and     generally                used
                                      in treatment       of      rheumatoid      arthritis.

                            Heavy        F!etal    Antagonists--Products                   used    primarily               to      treat          cer-
                                       tain     types    of poisoning.

                            Hormones   and Synthetic                  Substitutes--Products                    used           to    treat
                                  hormonal      deficiencies,                  inflammations,               diabetes,               and thy-
                                  roid   conditions.

                            Local      Anesthetics--Preparations                      used for relieving                        pain        on
                                      body surfaces,          joints,           and   mucous membranes.

                            Oxytocics       --Products         used      to     control      or    induce           uterine            con-
                                    tractions.

                            Radioactive     Agents          --Radioactive             products            used      most        frequently
                                   as diagnostic              agents     or      tracers.

                            Serums,         Toxoids,      and Vaccines   --Naturally                   occurring             substances
                                      generally        used to treat    or prevent                   infection              and to
                                      treat     certain      types  of poisoning.

                            Skin      and FIucous Membrane     Preparations                       --Products               used to
                                      treat  infections,   inflammations,                         and itching               of the            skin.

                            Spasmolytic           Agents --Products               which     act    largely      on smooth  mus-
                                  cle        tissue       in treating           asthma      and    occasionally      in treat-
                                  ing        gastrointestinal                disorders.

                            Vitamins       --Products        used       to    supplement          body      enzymes.

                            Unclassified           Therapeutic       Agents--  Products    of                     naturally                occur-
                                    ring       substances      which    are not classified                         elsewhere.