The chairman of the House Ways & Means Committee has asked long-term care pharmacists to help monitor and reduce antipsychotic use in nursing homes.

In letters sent last week to the National Community Pharmacists Association and the Senior Care Pharmacy Coalition, Rep. Richard Neal (D-MA) expressed concerns about what he called a “crisis” in overprescribing, characterizing off-label use of the drugs as “chemical restraint.” 

Noting that more than 20% of the nation’s nursing home residents receive antipsychotics while only 2% have a qualifying mental health diagnosis, Neal took issue with claims by the Centers for Medicare & Medicaid Services that the number of inappropriate prescriptions has fallen. Rather than reflecting a true reduction in prescriptions, the changes may stem from “falsified psychosis diagnoses,” he wrote.

The two pharmacy organizations were asked to identify best prescribing practices and to provide the chairman with detailed information on topics including:

  • The groups’ goals for reducing inappropriate prescriptions
  • Adherence to American Psychological Association recommendations on antipsychotic use in the elderly, including appropriate dosage, obtaining informed consent before off-label prescribing, and attempts to taper use
  • Data on guideline adherence among member pharmacies
  • Opportunities for LTC pharmacies or pharmacists to report suspected drug misuse
  • Medication oversight during transitions from hospitals to nursing facilities