April 21, 2010 Via Electronic Transmission Thomas W. Arnold Secretary Agency for Health Care Administration State of Florida 2727 Mahan Drive Tallahassee, FL 32308 Dear Secretary Arnold: In the United States, the federal and state governments spend roughly $317 billion every year on the Medicaid program. As Ranking Member of the Senate Committee on Finance, I have an obligation to ensure that taxpayer dollars are appropriately spent on federal health care programs. Like the Medicare program, Medicaid suffers from systemic weaknesses that lead to fraud, waste, and abuse across the program, resulting in higher costs and less health care to those who are in need. The overutilization of prescription drugs, whether through drug abuse or outright fraud, plays a significant role in the rising cost of our healthcare system. The purpose of this letter is to request information regarding certain outliers in Florida's Medicaid program and what steps Florida takes to monitor rates of utilization. In recent inquiries, I have asked the U.S. Department of Health and Human Services about physicians prescribing mental health drugs at astonishingly high rates. In addition to these concerns, a recent CNN report detailed the increasing abuse of OxyContin, Roxicodone, and Xanax. Specifically, the report described the role some pain management clinics and physicians play in the black market for these drugs. I write today to better ascertain how high rates of both mental health and pain medication utilization are affecting the Medicaid program, as well as how Florida's rates compare to the national rates. To that end, please provide charts that list of the top ten Medicaid prescribers of the following drugs for the years 2008 and 2009. For each prescriber, please provider his/her prescriber identifier, and the number of prescriptions written per drug per year, and the total amount billed to Medicaid per drug, separated for each year. ? ? ? ? ? Abilify; Geodon; Seroquel; Zyprexa; Risperdal; ? ? ? OxyContin; Roxicodone; and Xanax. I thank you in advance for your cooperation and request that you provide the requested documents and written responses by no later than May 5, 2010. In your reply, please format information into a chart like the examples provided below. All formal correspondence should be sent electronically in PDF format to Brian_Downey@financerep.senate.gov or via facsimile to (202) 228-2131. Of course should you wish to discuss this matter further, please do not hesitate to contact Christopher Armstrong of my Committee staff at (202) 224-4515. Sincerely, Charles E. Grassley Ranking Member Attachment 2 Drug X, 2008 Prescriber Identifier 123456789 234567891 345678912 456789123 567891234 678912345 789123456 891234567 912345678 012345678 Drug X, 2009 Prescriber Identifier 123456789 234567891 345678912 456789123 567891234 678912345 789123456 891234567 912345678 012345678 Total prescriptions 25,000 24,000 23,000 22,000 21,000 20,000 19,000 18,000 17,000 16,000 Total billed to Medicaid 250,000 240,000 230,000 220,000 210,000 200,000 190,000 180,000 170,000 160,000 Total prescriptions 25,000 24,000 23,000 22,000 21,000 20,000 19,000 18,000 17,000 16,000 Total billed to Medicaid 250,000 240,000 230,000 220,000 210,000 200,000 190,000 180,000 170,000 160,000 3