IG: 14.4 Million Medicare Part D Beneficiaries Got $4.1 Billion in Opioids in 2016

By Terence P. Jeffrey | November 6, 2017 | 4:28 PM EST

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(CNSNews.com) - A total of 14.4 million beneficiaries of Medicare Part D, which offers Medicare recipients the opportunity to get federally subsidized prescription drug coverage, received at least one prescription for an opioid in 2016 while the Medicare Part D program paid about $4.1 billion to provide them with those drugs, according to a study by the inspector general for the Department of Health and Human Services.

Nationwide, 33 percent of all Medicare Part D beneficiaries got federally funded opioids in 2016.

In Alabama, it went as high as 46 percent; in Mississippi, it was 45 percent; and, in Arkansas, it was 44 percent.

The IG’s discovery that 14.4 million Medicare Part D beneficiaries got an opioid prescription in 2016 was cited in a Government Accountability Office report released today.

“The Centers for Disease Control and Prevention (CDC), reported that from 1999 to 2014 the rate of drug poisoning deaths from prescription opioids nearly quadrupled from 1.4 to 5.1 per 100,000 people,” said the GAO report. “In addition, the Department of Health and Human Services (HHS) Office of Inspector General (HHS-OIG) reported that 14.4 million people (about one-third) who participate in Medicare Part D received at least one prescription for opioids in 2016, and that Part D spending for opioids in 2016 was almost $4.1 billion.”

The inspector general’s report—“Opioids in Medicare Part D: Concerns about Extreme Use and Questionable Prescribing”—was completed in July.

“In 2016,” said the IG report, “one out of every three beneficiaries received at least one prescription opioid through Medicare Part D.

“In total,” said the report, “14.4 million of the 43.6 million beneficiaries enrolled in Medicare Part D received opioids. Medicare Part D paid almost $4.1 billion for 79.4 million opioid prescriptions for these beneficiaries.”

“Several states had higher proportions of beneficiaries receiving opioids than the nation overall, which was 33 percent,” said the IG. “Alabama and Mississippi had the highest proportions, with almost half of the state’s Part D beneficiaries receiving at least one opioid—46 percent and 45 percent respectively. Arkansas had 44 percent of beneficiaries receiving opioids, while Oklahoma, Tennessee, and Louisiana each had 42 percent. The two lowest proportions were in Hawaii (21 percent) and New York (22 percent).”  

Some of the Medicare Part D beneficiaries received an opioid prescription only for a short period of time. But others received an opioid on what the IG called “a regular basis”—and some received “high” or “extreme” amounts.

Some beneficiaries also appeared to be “doctor shopping” in pursuit of opioids.

The IG report stated:

--“Specifically, 5 million beneficiaries received opioids for 3 months or more in 2016.”

--“A total of 501,008 beneficiaries received high amounts of opioids through Medicare Part D in 2016. This does not include beneficiaries who had cancer or were in hospice care.”

--“A total of 69,563 beneficiaries received extreme amounts of opioids for the entire year, putting them at serious risk of opioid misuse or overdose. Each of these beneficiaries had an average daily MED [morphine equivalent dose] that exceeded 240 mg for the entire year, This extreme amount is more than two and a half times the dose the CDC recommends avoiding for chronic pain patients.”

--“A total of 22,308 beneficiaries appear to be doctor shopping. Each of these beneficiaries received a high amount of opioids—an average daily MED that exceeded 120 mg for at least 3 months—and have four or more prescribers and four or more pharmacies in 2016. Typically, beneficiaries who receive opioids have just one prescriber and one pharmacy.”

The IG also report noted that a number of prescribers—including doctors, nurses and physician assistants—also exhibited extraordinary patterns in the opioid prescription they issued to Medicare Part D beneficiaries:

--“A total of 401 prescribers stand out as having questionable prescribing patterns; these prescribers ordered opioids for the highest numbers of beneficiaries at serious risk. The patterns of these 401 prescribers are far outside the norm and warrant further scrutiny.”

The report described in more detail the practice of one such prescriber from Florida:

--“One Florida physician repeatedly ordered extreme amounts of opioids for multiple beneficiaries. For one beneficiary in a single day, this physician ordered three opioids—oxycodone, and two different forms of fentanyl—that had a daily MED of 1,239 mg. In total this physician prescribed opioids to 125 beneficiaries who received extreme amounts. Part D paid $1.6 million for these drugs.”

The GAO report released today, which cited the IG’s finding that 14.4 million beneficiaries of Medicare Part D got $4.1 billion in opioid prescriptions in 2016, was done at the request of Sen. Pat Toomey (R.-Pa.) and Tim Kaine (D.-Va.).

The report recommended that the Centers for Medicare and Medicaid Services: “(1) gather information on the full number of at-risk beneficiaries receiving high doses of opioids, (2) identify providers who prescribe high amounts of opioids, and (3) require plan sponsors to report to CMS on actions related to providers who inappropriately prescribe opioids.”

“This report's findings are troubling and show that more needs to be done to protect seniors from the dangers of opioid overuse," said Sen. Kaine.

Sen. Toomey called on CMS to adopt the report’s recommendations.  "The Centers for Medicare and Medicaid Services should urgently adopt GAO's recommendations to better protect the health of opioid-using seniors and stop fraudulent prescribing,” he said.

In October, President Trump declared the national drug demand and opioid crisis a Public Health Emergency.


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