In light of continuing indicators of potential prescription-medication fraud and abuse in state Medicaid programs, the Government Accountability Office (GAO) has reviewed federal and state pharmacy-related policies and processes to prevent and detect such abuses. The GAO identified two potential controls that are not included in CMS's current reporting requirements: (1) lock-in programs for noncontrolled substances (which address "doctor shopping" by restricting beneficiaries who have abused the Medicaid prescription drug program to one health-care provider and/or pharmacy, for receiving prescriptions); and (2) prohibitions on automatic refills for certain medications. To enhance monitoring of potentially wasteful or abusive practices in the Medicaid program, the GAO recommends that CMS require states to report on whether they have adopted lock-in programs for abusers of noncontrolled substances and prohibitions on pharmacy automatic refills, and determine whether additional guidance in this area is appropriate. For details, see the complete report, "Medicaid: Additional Reporting May Help CMS Oversee Prescription-Drug Fraud Controls."
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