America's Other Drug Problem

AMERICA'S OTHER DRUG PROBLEM EXPRESS SCRIPTS Rx ABUSE AND PHARMACY FRAUD DEADLIER THAN COCAINE AND HEROIN COMBINED Each year, prescription drug overdoses KILL MORE THAN 15,000 AMERICANS and result in 1.2 MILLION ER VISITS'. Express Scripts is partnering with government agencies and a national network of healthcare providers to end this epidemic. COLLABORATING TO END THE EPIDEMIC THE MEDICAL MULTIPLIER A Comprehensive Fraud, Waste and Abuse Program LAW ENFORCEMENT 900,000+ PRESCRIBERS MEMBERS must include: FOR EVERY $1 of abused drugs obtained through "doctor shopping," + PROACTIVE DATA MINING AND PATTERN ANALYS IS 100M. an ADDITIONAL $41 ARE WASTED on related medical claims.3 EMPLOYERS EXPRESS SCRIPTS HEALTH PLANS + EVIDENCED-BASED PHARMACY AUDITS 1.4B + CLINICAL AND UTILIZATION MANAGEMENT PROGRAMS RXIYEAR DRUG COST HEALTHCARE WASTE + COMPLIANCE WITH ALL GOVERNMENT REQUIREMENTS DOJ 65,000+ MEMBER FRAUD4 PHARMACIES CMS The most frequently abused drugs are pain medications. These opioids, used together with benzodiazepines and muscle relaxers, deliver a heroin-like high. FRAUD TYPE MEMBER AGE FORGED PRESCRIPTIONS ID THEFT 18-34 22% 13% 11% DUPLICATIVE/ INAPPROPRIATE THERAPY 51-64 28% EXPRESS SCRIPTS IDENTIFIES TRENDS AND OUTLIERS: $500M 20% OTHER: 3% 65+ 13% DRUG SEEKING BEHAVIOR (ADDICTION) 35-50 37% 64% <18 ESTIMATED H EALTHCARE SAVINGS due to 435 AVERAGE ANNUAL INCREASE IN cases Express Scripts referred to the authorities in 2011. FRAUD RECOGNITION by Express PHARMACY FRAUD4 Scripts proactive data mining 290+ FRAUD TYPE PHARMACY LOCATION INDICATORS OF FRAUD F14% Express Scripts has identified, including: 86% EAST 26% OTHER WEST 20% NUMBER OF DOCTORS VISITED • PHANTOM PHARMACIES CENTRAL 6% • ID THEFT DISTANCE TRAVELED TO PHYSICIAN OR PHARMACY FALSE BILL ING • COLLUSION WITH PILL MILLS • BILLING FOR DRUGS NOT DISPENSED FREQUENCY OF PRESCRIPTIONS • BILLING FOR INCORRECT QUANTITIES SOUTH 48% • OVERBILLING GEOGRAPHY AND PATIENT POPULATION MIX OF DRUGS DISPENSED 'U.S. Centers for Dis ease Control and Prevention. Feb 2012. htt p://www.cdc.gov/Feat ures/Vital Signs/PainkillerOverdoses/ 2 U.S. Substance Abuse and Mental Health Services Adm inistration. Dec 2010. http://www.oas.sam hsa.gov/2k10/DAWNO34/EDHighlights.htm 3 Research from WellIPoint, Inc. Dec 2007. http://www.insurancefraud.org/downloads/drugDiversion.pdf 4 Based on all cases identi fied by Express Scripts ©2012 Express Scripts Holding Company. All rights reserved. For more healthcare insights, visit Lab. Express-Scripts.com.