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National Review of Opioid Prescribing in Medicaid Is Not Yet Possible

WHY WE DID THIS STUDY

Historically, national Medicaid data—a collection of data submitted by all States—have not been complete, accurate, and timely. These data have not yet been adequate for national analysis and oversight, even though some States' data have been sufficient for individual State analysis. Because of concerns with the quality and completeness of the national Medicaid claims database-the Transformed Medicaid Statistical Information System (T-MSIS)-we assessed the completeness of variables needed to monitor national opioid prescribing in Medicaid.

HOW WE DID THIS STUDY

We assessed variables needed to identify (1) beneficiaries at risk of opioid misuse or overdose (i.e., variables needed to calculate beneficiaries' total opioid dosage, and diagnosis codes to exclude patients for whom higher doses of opioids may be appropriate) and (2) the National Provider Identifiers (NPIs) of providers that ordered and dispensed opioids (i.e., prescribers and pharmacies, respectively).

WHAT WE FOUND

A national review of opioid prescribing in Medicaid using T MSIS is not yet possible because not all at-risk beneficiaries and providers can be identified. Limitations of T-MSIS data impede identification of individual beneficiaries for national opioid analysis. Further, 32 States were missing NPI, diagnosis code, or quantity. For the 19 States that were missing pharmacy or prescriber NPI, States were most frequently missing pharmacy NPI.

WHAT WE RECOMMEND

To ensure the identification of at-risk beneficiaries and providers who may be overprescribing, we recommend that CMS (1) work to ensure that individual beneficiaries can be uniquely identified at a national level using T-MSIS, (2) ensure the correct submission of prescriber NPIs, and (3) clarify requirements for diagnosis codes. CMS concurred with all three recommendations.