The Office of the Inspector General (OIG) for the Department of Health and Human Services (DHHS) reports (oig.hhs.gov) that nearly 12 million Medicare patients received at least one prescription for opioid painkillers at a cost of over $4 billion in 2015.  This represents one third of all Medicare beneficiaries receiving commonly abused opioids such as OxyContin, Percocet, Vicodin, and Fentanyl.  On average, each of these beneficiaries received five prescriptions for commonly abused opioids during the year. The OIG report raises the need for further scrutiny of the trends in Part D spending for opioid pain medicine to ensure appropriate use of these drugs, and to protect the integrity of the Part D Medicare prescription drug program.  The report states that these high rates of use provide further evidence of a crisis facing the Nation in regards to abuse opioid prescription drugs.

The proportion of beneficiaries receiving opioids was higher in several states. Alabama had the highest number of Medicare patients receiving pain medicine, with 42 percent. Forty percent of Medicare patients in Mississippi, Tennessee, Oklahoma, and Arkansas received commonly abused opioids.  New York and Hawaii dispensed the lowest proportion of opioid drugs, where 21 percent of Medicare patients received commonly abused opioids.

Overall spending for Part D drugs has continued to rise by more than 10 billion a year, according to the federal report. In 2014, over 40 million beneficiaries enrolled in the Medicare Part D program.  Private companies contract with the Centers for Medicare & Medicaid Services (CMS) to provide drug benefits to enrollees. Since the program’s inception in 2004, spending overall for Part D drugs has increased by 167 percent, growing from 51.3 billion to 137 billion.

Protecting the Safety of Medicare Patients

CMS spokesperson Miriam Anderson, who led the study, stated that “we are concerned about the high spending and the number of people receiving opioids.  This raises concerns about abuse.  This is a serious problem facing our country.”  The federal report shows that this is just not a young person’s problem. Overdose use and death with opioids is an increasing problem for older Americans, especially when used with other medications and alcohol.

CMS has taken a number of actions to combat the high use of commonly abused opioids. For example, CMS now identifies both high risk patients and outlier prescribers and disseminates this information to the Part D plan sponsors. The OIG recommends that the CMS take additional measures to combat the high use of opioid drugs by the Medicare population.

Source: HHS OIG Data Brief, June 2016, “High Part D Spending on Opioids and Substantial Growth in Compounded Drugs Raise Concerns”

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