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Opioid Use in Medicare Part D Remains Concerning

WHY WE DID THIS STUDY

The opioid crisis was recently declared a public health emergency. In 2016, more than 42,000 opioid-related overdose deaths occurred in the United States-115 deaths per day. This data brief is part of a larger strategy by OIG to fight the opioid crisis and protect beneficiaries from prescription drug misuse and abuse. This data brief provides 2017 data on the extent to which Medicare Part D beneficiaries receive extreme amounts of opioids or appear to be doctor shopping and compares these data to OIG's previous analysis of 2016. It also identifies prescribers who have questionable opioid prescribing.

HOW WE DID THIS STUDY

We based this data brief on an analysis of Part D prescription drug event records for opioids received in 2017. We determined beneficiaries' morphine equivalent dose (MED), which is a measure that converts all of the various opioids and strengths into one standard value.

WHAT WE FOUND

  • Nearly one in three Part D beneficiaries received a prescription opioid in 2017.
  • Overall Part D spending for opioids decreased due in part to declining prices.
  • Almost 460,000 beneficiaries received high amounts of opioids in 2017, fewer than in 2016.
  • About 71,000 beneficiaries are at serious risk of opioid misuse or overdose, also fewer than in 2016.
  • Almost 300 prescribers had questionable opioid prescribing for the 71,000 beneficiaries at serious risk.

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, the severity of the opioid crisis makes it imperative that HHS, including CMS and OIG, continues to work together to develop new strategies to address this epidemic. As a part of these efforts, CMS is implementing a number of new initiatives in 2019. OIG is also working to increase its efforts to fight the opioid crisis by working with our law enforcement partners and identifying other approaches to support prevention and treatment and to improve the effectiveness of broader Department efforts. OIG is also committed to continue forging relationships with States and the private sector. We encourage Part D sponsors to work with OIG and CMS to further improve efforts to combat opioid misuse, for example, by implementing their new "lock in" authority. Further, we support States' efforts to implement and enforce strong prescriptions drug monitoring programs. 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