Opioid Use in Medicare Part D Continued To Decline in 2019, but Vigilance Is Needed as COVID-19 Raises New Concerns

WHY OIG DID THIS REVIEW

The United States has been grappling with the opioid crisis for several years. In 2018, nearly 47,000 opioid-related overdose deaths occurred in the United States. OIG has been tracking opioid use in Medicare Part D since 2016. In particular, OIG has identified beneficiaries at serious risk of opioid misuse or overdose and prescribers with questionable opioid prescribing for these beneficiaries.

This data brief provides important information on opioid use in Medicare Part D in 2019, before the coronavirus disease 2019 (COVID-19) pandemic. This information is critical to understanding trends in opioid use. This data brief will also provide comparison points for a forthcoming OIG data brief, which will examine changes in opioid use that occurred during the pandemic in 2020.

WHAT OIG FOUND

• About one in four Medicare Part D beneficiaries received opioids in 2019, a decrease from the prior 3 years.
• At the same time, the number of beneficiaries receiving drugs for medication-assisted treatment (MAT drugs) for opioid use disorder has steadily increased in recent years, reaching 209,000 in 2019.
• The number of beneficiaries receiving prescriptions through Part D for naloxone-a drug that can reverse the effects of an opioid overdose-has also continued to grow.
• 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.
• About 140 prescribers had questionable opioid prescribing for beneficiaries at serious risk.

WHAT OIG CONCLUDES

As of 2019, opioid use in Part D had decreased and the use of MAT drugs and the availability of naloxone had increased. Together, these changes show progress from the efforts of the Department of Health and Human Services—and others—to address the opioid crisis. Nonetheless, it is critical to remain vigilant. The current COVID-19 pandemic makes the need to look at this population even more pressing. Early reports for 2020 indicate that overdose deaths are rising in some areas of the country. The National Institute on Drug Abuse—part of the National Institutes of Health—warned that individuals with opioid use disorder could be particularly hard hit by COVID-19 as it is a disease that attacks the lungs, and respiratory disease is known to increase the risk of fatal overdose among people taking opioids. In addition, a number of rules related to telehealth and the prescribing of opioids have been relaxed in response to COVID-19 to ensure greater access to legitimate prescribing during the pandemic. These changes may unintentionally increase the risk of doctor shopping and inappropriate opioid prescribing in 2020. Ensuring the appropriate use and prescribing of opioids is essential to protecting the health and safety of beneficiaries and the integrity of Part D. OIG is committed to continuing our work on opioid use and access to treatment in 2020 and beyond. Likewise, we encourage CMS to also closely monitor opioid use and access to treatment in 2020 and beyond.