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Opioids in Medicare Part D: Concerns about Extreme Use and Questionable Prescribing

WHY WE DID THIS STUDY

Opioid abuse and overdose deaths are at epidemic levels in the United States. This data brief is part of a larger strategy by the OIG to fight the opioid crisis and address one of its top priority outcomes-to protect beneficiaries from prescription drug abuse. It provides baseline data on the extent to which beneficiaries receive extreme amounts of opioids and appear to be "doctor shopping." It also identifies prescribers who have questionable opioid prescribing patterns.

HOW WE DID THIS STUDY

We based this data brief on an analysis of prescription drug event records of opioids received in 2016. We determined beneficiaries' morphine equivalent dose (MED), which is a measure that equates all of the various opioids and strengths into one standard value.

WHAT WE FOUND

  • One in three Medicare Part D beneficiaries received a prescription opioid in 2016
  • About 500,000 beneficiaries received high amounts of opioids
  • Almost 90,000 beneficiaries are at serious risk; some received extreme amounts of opioids, while others appeared to be doctor shopping
  • About 400 prescribers had questionable opioid prescribing patterns for beneficiaries at serious risk; these patterns are far outside the norm and warrant further scrutiny.

WHAT WE CONCLUDE

Ensuring the appropriate use and prescribing of opioids is essential to protecting the health and safety of beneficiaries and the integrity of Part D. Prescribers play a key role in combatting opioid misuse. They must be given the information and tools needed to appropriately prescribe opioids when medically necessary. At the same time, we must address prescribers with questionable prescribing patterns for opioids to ensure that Medicare Part D is not paying for unnecessary drugs that are being diverted for resale or recreational use. OIG is committed to continuing investigations and evaluations to address this issue.

In addition, we are committed to forging expanded partnerships among Federal agencies, States, and private sector partners. We specifically call on Part D sponsors to work with OIG and CMS to further improve efforts to combat opioid misuse in Medicare. We also encourage Part D sponsors to effectively use CMS's Overutilization Monitoring System, which identifies beneficiaries who are potentially overutilizing opioids. We further encourage sponsors to implement drug management programs for at-risk beneficiaries, following additional guidance from CMS. By working together and expanding our efforts in Part D, we can help curb the opioid crisis in our Nation.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

Download the complete report.

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201