Opioid use among Part D members is down but ‘remains concerning’

Data from the Medicare Part D program show fewer beneficiaries are receiving high amounts of opioids, but a watchdog agency says usage “remains concerning,” while urging insurers to further restrict at-risk patients with lock-in programs.

The number of beneficiaries receiving high amounts of opioids through Part D coverage declined 8% in 2017 from just over 500,000 in 2016 to nearly 459,000, according to a report (PDF) by the Office of Inspector General.

The number of beneficiaries that received an “extreme” amount of opioids—defined as a daily dose more than two-and-a-half times the CDC’s recommendation for chronic pain patients over the course of the year—dropped 17% in the last year, from 69,500 to 57,600.

Doctor shopping declined even more precipitously, with 14,800 beneficiaries receiving excessive amounts of opioids at from multiple prescribers or pharmacies in 2017 compared to 22,300 the previous year.

However, 1 in 3 Part D beneficiaries still received at least one prescription opioid, and the overall level of opioid use “continues to raise concerns,” the OIG said.

While OIG has ramped up efforts to identify instances of inappropriate prescribing by partnering with states to identify instances of fraud, the agency called on insurers to implement new lock-in authority under the Comprehensive Addiction and Recovery Act of 2016, which allows Part D sponsors to restrict at-risk beneficiaries to select pharmacies and prescribers.

“We also call on Part D sponsors to work with pharmacies to ensure that the new point-of-sale care coordination alerts are implemented and effective,” the OIG wrote. “Specifically, sponsors should ensure that when these controls are triggered, the pharmacists consult with the prescribers before dispensing additional opioids.”

On the enforcement side, this week the OIG along with the Department of Justice announced charges against 601 individuals with fraud crimes totaling $2 billion. A sizable portion of that national takedown was devoted to opioid fraud, with 76 doctors charged for their role in diversion schemes.

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