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Arizona Daily Star
Stephanie Innes

Arizona last year spent at least $5.3 million on 11 powerful pain and antipsychotic medications for its poorest residents.

The medications are the target of U.S. Sen. Charles Grassley, R-Iowa, who is concerned they are being overprescribed in some parts of the country.

As a result, Arizona recently submitted spending data on the drugs to Grassley, a member of the Senate Finance Committee, who is calling for a federal investigation into the volume of drugs that the government is paying for through Medicare and Medicaid.

Grassley\’s findings have included a Miami doctor who wrote nearly 97,000 prescriptions for mental-health drugs in 21 months for Medicaid patients. None of the Arizona Medicaid prescribers came close to that level of prescribing. Arizona\’s top prescribers wrote between 500 and 3,000 prescriptions per provider per year for several of the drugs under scrutiny.

Arizona\’s largest expenditure on any single drug for the 2009 fiscal year was on Zyprexa, a drug used to treat the symptoms of schizophrenia, state data show. The state spent at least $1.3 million on Zyprexa for Medicaid patients in 2009.

The highest state expenditure paid for prescriptions by any one Arizona Medicaid-contracted medical provider in the 2009 fiscal year was $663,017 for 1,531 Abilify prescriptions written by a Tempe psychiatrist. Abilify is an antipsychotic and antidepressant used in the treatment of schizophrenia, bipolar disorder, and clinical depression. The tenth-highest Arizona Medicaid prescriber of Abilify, by contrast, wrote 629 prescriptions for the drug.

Grassley wants the government to more closely scrutinize top prescribers.

\”The overutilization of prescription drugs, whether through drug abuse or outright fraud, plays a significant role in the rising cost of our health-care system,\” Grassley wrote in a letter earlier this year to Thomas J. Betlach, director of the Arizona Health Care Cost Containment System (AHCCCS), Arizona\’s Medicaid program.

About 1.3 million people are enrolled in AHCCCS. The average monthly enrollment of AHCCCS members who accessed behavioral health services in 2009 was 109,000.

The Arizona data lists the top 10 AHCCCS contractors according to their volume of prescriptions for the medications Alprazolam, Oxycodone, Oxycontin, Roxicodone, Xanax, Abilify, Geodon, Seroquel, Zyprexa, Risperdal and Risperidone.

AHCCCS officials would not comment on the state data and Grassley\’s request, other than to say they have not been contacted by Grassley\’s office with any concerns regarding the Arizona data.

The Arizona Department of Health Services says its per-patient spending on behavioral-health medications for AHCCCS enrollees has held steady for the past few years, and last year was $1,074 per adult and $881 per child.

Federal and state governments spend about $317 billion per year on Medicaid, according to Grassley\’s office.

One of Arizona\’s top prescribers of the pain medications Oxycontin and Oxycodone to Medicaid patients last year has since had his contract terminated by the state. Phoenix area pain physician Dr. Angelo Chirban\’s contract with AHCCCS ended as a result of action by the Arizona Medical Board, AHCCCS officials say.

The Arizona Medical Board placed a practice restriction on Chirban in June after learning Chirban had surrendered his U.S. Drug Enforcement Administration license following a DEA investigation into his pain management clinics.The Medical Board this month also sent Chirban a letter of reprimand following an investigation into a complaint of inappropriate prescribing. Chirban signed the letter to resolve the matter, not as an admission of wrongdoing, according to board documents.

State data show Chirban wrote 2,977 prescriptions for Oxycontin and different types of Oxycodone (controlled release and immediate release) for AHCCCS enrollees in the 2009 fiscal year. The state paid a total of at least $527,449 for the drugs he prescribed to those patients.