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Opioid Use in Medicare Part D in 2017

Research shows that the risk of opioid dependence increases substantially for patients receiving opioids continually for 3 months.

  • Nearly 1 in 3 Part D beneficiaries received at least 1 prescription opioid
  • 76 million: number of opioid prescriptions paid for by Part D
  • 1 in 10 Part D beneficiaries received opioids for 3 months or more

Identifying patients who are at risk of overdose or abuse is key to addressing the national crisis.

Almost 460,000 Part D beneficiaries received high amounts of opioids.

About 71,000 beneficiaries are at serious risk of opioid misuse or overdose.

Almost 300 prescribers had questionable opioid prescribing patterns for the 71,000 beneficiaries at serious risk

OIG continues to support our State and private sector partners through Healthcare Fraud Prevention Partnership and our shared commitment to reducing the harm of opioids.

The severity of the opioid crisis makes it imperative that OIG and HHS partners continue to working together to develop new strategies to address the epidemic.

Taxpayer Cost Savings from Opioid-Related Exclusions

Through enforcement actions and exclusion, Medicare will save $200 million over the next 5 years.

Since the 2017 takedown (exclusions issued from June 2017-May 2018), OIG excluded 587 providers for misconduct related to opioids. Each exclusion protects taxpayers from bearing the costs of questionable prescriptions and services from untrustworthy health care providers.

Opioid-Related Exclusions

Since the 2017 takedown (exclusions issued from June 2017-May 2018), the HHS Office of Inspector General's Exclusions Program issued notices to 587 health care providers, including doctors, nurses, pharmacy employees and other individuals who were convicted of health care fraud, patient abuse or neglect, or illegal activity tied to opioids.

Top 5 States with Exclusions

  • North Carolina: 53
  • New York: 51
  • Ohio: 45
  • Massachusetts: 41
  • Oklahoma: 37

Exclusions by Occupation

  • Nurses: 402
  • Doctors: 67
  • Pharmacy Services: 40

Source: Opioid Use in Medicare Part D Remains Concerning, 2018

Learn more at https://oig.hhs.gov/opioidsdatabrief2018

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