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Medicare Part D Beneficiaries at Serious Risk of Opioid Misuse or Overdose: A Closer Look


As the Nation continues to struggle with the opioid crisis, it is vital to gain a deeper understanding of those who are at risk of misuse or overdose. The 2020 COVID-19 pandemic makes the need to look at this population even more pressing. The National Institutes of Health recently issued a warning that individuals with opioid use disorder could be particularly hard hit by COVID-19, as it is a disease that attacks the lungs. Respiratory disease is known to increase the mortality risk among people taking opioids.

OIG has been tracking opioid use in Medicare Part D throughout the opioid crisis. OIG identified 71,260 Part D beneficiaries at serious risk of misuse or overdose in 2017; each of these beneficiaries received extreme amounts of opioids or appeared to be doctor shopping. This data brief provides a deeper understanding of these beneficiaries by examining their Medicare claims from 2017 and 2018 and determining the following: their opioid amounts; the extent to which they had opioid overdoses; the extent to which they received naloxone through Medicare Part D; and the extent to which they have a diagnosis of opioid use disorder and received drugs for medication-assisted treatment (MAT drugs) through Part D. This information is critical to helping the Department of Health and Human Services (HHS) target its efforts to combat the opioid crisis.



Although opioids can be appropriate under certain circumstances, steps should be taken to mitigate the risk of misuse and overdose, especially when beneficiaries receive high amounts of opioids for long periods of time. This data brief also demonstrates that opportunities exist for CMS to expand its role in ensuring that beneficiaries receive treatment for opioid use disorder. Although CMS is taking some significant steps, we recommend that CMS educate Part D beneficiaries and providers about access to MAT drugs and naloxone. CMS concurred with our recommendation.