Concerns Persist about Opioid Overdoses and Medicare Beneficiaries' Access to Treatment and Overdose-Reversal Drugs

WHY OIG DID THIS REVIEW

The coronavirus disease 2019 (COVID-19) pandemic and its effects on the provision of health care have heightened concerns about opioid use and access to treatment. The pandemic has put people with opioid use disorder at particular risk, as they are at higher risk of developing COVID-19 and are more likely to experience hospitalizations or death from the illness. These increased risks posed by COVID-19 make urgent the need to monitor opioid use as well as access to treatment and to the opioid overdose-reversal drug naloxone.

OIG has been tracking opioid use and access to treatment and naloxone in Part D for the past several years. Before 2020 and the COVID-19 pandemic, there were consistent decreases in opioid use in Part D. There was also growth in the use of medications to treat opioid use disorder—referred to as medication-assisted treatment (MAT) drugs—and naloxone. This data brief provides important information on opioid use, MAT drugs, and naloxone in Medicare Part D in 2020. It builds on a previously released OIG data snapshot about opioid use during the onset of the pandemic.

WHAT OIG FOUND

• More than 43,000 Medicare Part D beneficiaries suffered an opioid overdose—from prescription opioids, illicit opioids, or both—in 2020.
• Nearly 1 in 4 Part D beneficiaries received opioids during 2020. The number of beneficiaries receiving short-term opioid prescriptions dropped sharply in the early months of the pandemic, likely the result of a decrease in elective surgeries at that time.
• The number of beneficiaries who received MAT drugs through Part D increased, but at a slower rate in 2020 than in prior years. And, unlike in other recent years, there was no growth in the number of beneficiaries receiving prescriptions for naloxone through Part D. These changes are likely related to COVID-19—patients may have avoided seeing their health care providers during the pandemic, reducing the opportunity for providers to offer treatment.
• The slower growth rates in the numbers of beneficiaries receiving MAT drugs and naloxone add to ongoing concerns about access to MAT drugs and naloxone.

WHAT OIG CONCLUDES

Monitoring opioid use and access to MAT drugs and naloxone has always been critical to fighting the opioid crisis in this country. The COVID-19 pandemic has made these efforts even more pressing. A May 2020 OIG data brief recommended that CMS educate Part D beneficiaries and providers about access to MAT drugs and naloxone. We continue to encourage CMS to take these steps. It is also critical for CMS to closely monitor the number of beneficiaries receiving MAT drugs and naloxone and take action, if needed. OIG is also committed to continuing our work on opioid use and access to treatment.