Earlier this year, the Department of Health and Human Services Office of Inspector General (HHS-OIG) completed a report in which it reviewed opioid use in Medicare Part D. While the study and report were done prior to the COVID-19 pandemic, it is critical for understanding trends in opioid use. The data brief also providers comparison reports for a forthcoming OIG data brief that will examine changes in opioid use during the pandemic.
OIG found that about 25% of Medicare Part D beneficiaries received opioids in 2019, a decrease from the prior three years, and spending for opioids in Part D decreased to the lowest amount in ten years, $2.8 billion. In 2019, Part D paid for almost 67 million opioid prescriptions: an average of 5.3 prescriptions per beneficiary receiving opioids. This is a decrease from 2018, 2017, and 2016, when Part D paid for 71 million, 76 million, and 79 million opioid prescriptions, respectively.
At the same time, the number of beneficiaries receiving drugs for medication-assisted treatment (MAT drugs, such as buprenorphine and naltrexone) for opioid use disorder has continued to steadily increase in recent years, for a total of 209,090 patients in 2019, a 20 percent increase from 2018.
Additionally, the number of beneficiaries receiving prescriptions through Part D for naloxone (a drug that can reverse the effects of an opioid overdose) has continued to grow – a 70 percent increase from 2018 – and nearly 267,000 beneficiaries received high amounts of opioids in 2019, with almost 34,000 of them at serious risk of opioid misuse or overdose.
OIG also found that 142 prescribers had questionable opioid prescribing for beneficiaries at serious risk as they were “far outside the norm with their prescribing and warrant further scrutiny.” OIG specifically cites 84 prescribers who each ordered opioids for at least 32 beneficiaries who received extreme amounts of opioids in 2019 and 62 prescribers who each ordered opioids for at least 10 beneficiaries who appeared to be doctor shopping. However, the number of prescribers with questionable prescribing practices has decreased each year since 2016.
Overall OIG concluded that the decrease of opioid use in Part D and the increase in the use of MAT drugs and the availability of naloxone indicate progress is being made in combatting the opioid crisis. OIG does state, though, that even though it seems progress is being made, “it is critical to remain vigilant” and that the
COVID-19 pandemic makes the need to look at this population even more pressing.” Early reports indicate that overdose deaths are rising in some areas of the country and the National Institute on Drug Abuse warned that individuals with opioid use disorder could be hit hard by COVID-19 because it is a respiratory condition, which are known to increase the risk of fatal overdose among people taking opioids. Additionally, with the rules related to telehealth and the prescribing of opioids being relaxed to ensure greater access to legitimate prescribing during the pandemic, the changes may also unintentionally increase the risk of doctor shopping and inappropriate opioid prescribing this year.