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OIG Update on Opioid Use In Medicare Part D

The opioid crisis has been declared a public health emergency, with more than 42,000 opioid-related overdose deaths occurring in the United States in 2016. That figure is twice the amount of deaths that were reported in 2010. The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued a data brief on opioid fraud, abuse, misuse, and drug diversion— the redirection of prescription drugs for an illegal purpose — in the Medicare Part D (Part D) program. The data brief is part of a larger OIG strategy to fight the opioid crisis and protect beneficiaries from prescription drug misuse and abuse. The OIG highlighted the following statistics in its brief:

  • Nearly one in three Part D beneficiaries received a prescription opioid in 2017;
  • Overall Part D spending on opioids decreased, due in part to declining prices;
  • Almost 460,000 beneficiaries received high amounts of opioids in 2017, though fewer than in 2016;
  • About 71,000 beneficiaries were at serious risk of opioid misuse or overdose in 2017; and,
  • Almost 300 prescribers exhibited questionable opioid prescribing for the beneficiaries at serious risk.

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Opioid Crisis Initiatives

Part D prescribers play a key role in combating opioid misuse, and they must be given the information and tools to appropriately prescribe medically necessary opioids. To that end, the Centers for Medicare & Medicaid Services (CMS) and the OIG are working on the following initiatives:

  1. CMS is working to implement the Comprehensive Addiction and Recovery Act of 2016, which provides Part D sponsors with the authority to restrict or “lock-in” at-risk beneficiaries to selected pharmacies or prescribers to obtain their opioid prescriptions.
  2. CMS is in the process of implementing a number of new initiatives in 2019 to address opioid overutilization, including the implementation of care coordination alerts at a point of sale when a beneficiary’s total daily dosage exceeds a certain threshold.
  3. OIG is supporting states’ efforts to implement and enforce strong prescription drug monitoring programs that require prescribers to check the respective state database before prescribing and dispensing opioids and encouraging greater access to that data.
  4. OIG is also working with CMS and law enforcement partners, including the Department of Justice’s new Opioid Fraud and Abuse Detection Units, to follow up on identified prescribers.

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