By Sheryl Allenson, J.D.
Opioid use has decreased among Part D beneficiaries along with an increase in MAT services for disorder in the past two years.
According to a study conducted by the Office of Inspector General (OIG), the use of opioids by Medicare Part D beneficiaries has decreased over the past two years while more Medicare beneficiaries received medication-assisted treatment (MAT) for opioid use disorder and naloxone has been more available. Taken together, the OIG found that in 2018, there was progress made in decreasing opioid use in Medicare Part D beneficiaries. Nonetheless, the OIG said it was "imperative" that HHS continue to work to address the opioid epidemic (OIG Report, OEI-02-19-00390, July 8, 2019).
Although three in 10 Medicare Part D beneficiaries received opioids in 2018, this represented a significant decline over the past two years, according to the OIG report. The report also indicated that in 2018, the number of Medicare Part D beneficiaries receiving high amounts of opioids decreased over the past two years, as did the number of beneficiaries at "serious risk" of opioid misuse or overdose. At the same time, use by Medicare Part D beneficiaries of MATs increased. Additionally, the number of beneficiaries that received prescriptions for naloxone, which is a drug that can reverse the effects of an opioid overdose, more than doubled from 2017 to 2018. The report also addressed issues regarding prescribers of opioids.
Significant decrease. In its study, the OIG found a significant decrease in the percentage of Medicare Part D beneficiaries who received at least one opioid prescription, from 33 percent in 2016 and 31 percent in 2017 to 29 percent of beneficiaries in 2018. According to the report, Part D spending for opioids has also decreased over the same time frame.
At the same time, the OIG found that in 2018 there has been progress in increasing the use of MATs by beneficiaries. Moreover, naloxone was increasingly available. In 2018, the number of beneficiaries that received MAT drugs through Part D rose to 174,000, an increase of 22 percent from the previous year. The number of prescriptions for MAT drugs also increased, rising 24 percent each year from 2016 to 2018. With respect to naloxone, the OIG found that the number of Medicare Part D beneficiaries who received the drug from Part D more than doubled from 2017 to 2018. The total number of prescriptions for the drug more than doubled from 2016 to 2017, and again from 2017 to 2018.
There was also a decrease in the number of beneficiaries receiving high amounts of opioids and in the number of beneficiaries at "serious risk" of misuse or overdose. Specifically, in 2018 nearly 354,000 beneficiaries (who did not have cancer and who were not in hospice) received high amounts of opioids, representing a 23 percent decrease from 2017. The report explained that each of these beneficiaries had an average morphine equivalent done (MED) in excess of 120 mg per day for at least three months. According to the OIG, the Centers for Disease Control and Prevention (CDC) recommends that prescribers use caution when prescribing opioids at any dose and that they "avoid increasing dosages to the equivalent of 90 mg or more MED a day for chronic pain. (footnote omitted)."
The OIG also reported that about 49,000 of the beneficiaries (again, who did not have cancer and were not in hospice care) fell into two groups that were at "serious risk of opioid misuse or overdose." The first group, representing more than 40,000, were beneficiaries who received "extreme amounts of opioids" and the second, representing about 8,800, were those who appeared to be doctor shopping. 612 beneficiaries fell into both groups. Although the OIG acknowledged that there were still a very high number of beneficiaries still at serious risk, the agency noted that the 2018 findings showed a significant drop from each group in 2016 and 2017. More specifically, there was a larger drop in the number of people appearing to be doctor shopping.
Additionally, the report considered the actions of prescribers, finding that the number of prescribers with "questionable opioid prescribing" practices for beneficiaries at serious risk similarly decreased in 2018 from those identified in 2016 and 2017. According to the OIG, approximately 200 prescribers "stood out as having questionable prescribing," having ordered more than 112,028 opioid prescriptions in 2018 for a large number of beneficiaries who were at serious risk.
Taken as a whole, the outlook reported was brighter in 2018 than in previous years. The OIG acknowledged that though opioid use may be necessary for some, "the extreme use of opioids and apparent doctor shopping described in this study raise concern." Although OIG said the decreases noted in the report demonstrate the "value of awareness, drug treatment, and law enforcement efforts in addressing the opioid crisis," it concluded that it was "imperative" that further work continue.
MainStory: TopStory OIGReports CMSNews ControlledNews PartDNews
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