Medicare Part D Struggles with Opioid Epidemic, Overprescribing Concerns

Audit by Inspector General shows thousands of patients may be 'doctor shopping'

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July 15, 2018

A report by the inspector general for the Department of Health and Human services says that Medicare Part D, the program designed to help seniors afford drug prescriptions, is struggling with concerns of overprescribing, and also points to thousands of situations in which the level of prescriptions for some patients is creating risk of overdose deaths.

The investigation looked at prescribing information from 2017, and noted small gains compared to the previous year, but those gains were still overshadowed by the enormity of the overall risk, especially because opioid use can produce more negative side effects for a senior such as risk of secondary injury when compared to a younger adult.

"Opioid use among Medicare Part D beneficiaries has decreased slightly but remains concerning," the report said in its conclusion. "Nearly one in three beneficiaries received a prescription opioid through Part D in 2017. Despite this decrease, the high level of opioid use in Part D continues to raise concerns."

Some highlights of the report show:

  • About 4.9 million Part D beneficiaries received opioids for three or more months in 2017, a red flag for the IG.
  • Nearly 58,000 patients received "extreme amounts" of opioids with prescription levels two-and-a-half times the recommended dose, "putting them at serious risk of opioid misuse or overdose."
  • "A total of 14,814 beneficiaries appear to be doctor shopping" with these patients being prescribed high levels of opioids, but also having "four or more prescribers and four or more pharmacies in 2017."

Especially concerning with regards to doctor shopping is the possibility the patient will divert the drugs for resale to the black market for others' recreational drug use, which only serves to perpetuate the epidemic.

"A beneficiary in Washington, D.C., received 101 opioid prescriptions from 26 prescribers and filled them at 28 pharmacies in 2017," the IG illustrated. "Over the course of the year, this beneficiary received more than 10,000 pills containing oxycodone. In one month alone, this beneficiary received 16 opioid prescriptions from 11 different prescribers and filled them at 12 pharmacies."

While that anecdote put a patient's behavior in the spotlight, there were concerning behaviors from some doctors as well.

"A physician in Florida ordered opioids for 192 beneficiaries who received extreme amounts during the year," the report said. "In total, this physician ordered 2,692 opioid prescriptions for beneficiaries who received extreme amounts of opioids, costing Part D $570,000."

As the opioid epidemic has continued across the country, government-managed health services have had to do deep investigations of how the programs allow opioids to be prescribed. For example, Wisconsin senator Ron Johnson (R.) held a hearing earlier this year examining how the Medicaid expansion allowed by the Affordable Care Act may have contributed to increased opioid availability in the black market.

On Thursday, Attorney General Jeff Sessions announced a new tactic in the broader opioid war, targeting a spike in use and overdoses from synthetic opioids, like fentanyl.

"Although the rate of prescription opioid overdoses has risen steadily for years, the major driver of the OD death boom in the last several years was first heroin, and then fentanyl and other synthetic opioids," the Free Beacon reported. "The Center for Disease Control said Thursday that the supply of synthetics is increasing, projecting more synthetic deaths in 2017 than in 2016."

Published under: Medicare , Opioids