Opioid abuse and overdose deaths in the U.S. are at epidemic levels, in part due to an increased level of fraud within the Medicare Part D program, according to a report released by the inspector general of the U.S. Department of Health and Human Services.
A total of 69,563 Medicare beneficiaries received extreme amounts of opioids, and 22,308 beneficiaries appeared to be doctor shopping -- receiving high amounts of opioids by having multiple prescribers and pharmacies. In 2016 one beneficiary received opioids from 46 different prescribers and 20 different pharmacies. In one month alone, this beneficiary received 11 different opioid prescriptions from eight prescribers in five different states, and filled these prescriptions at six different pharmacies.
Moreover, 678 beneficiaries received even more extreme amounts of opioids. In one case, a beneficiary from New Hampshire received 134 prescriptions for opioids from one prescriber in 2016.
“Receiving extreme amounts of opioids raises concerns,” the authors write. “It may indicate the beneficiary is receiving medically unnecessary drugs, which could be diverted for resale. It may also indicate the beneficiary is addicted to opioids and at risk of overdose. Alternatively, it may indicate a beneficiary’s identification number has been stolen or sold.”
Such practices also increase the chance for overdose death, according to the report. In 2015, the number of opioid-related deaths exceeded 33,000 for the first time.
In addition to the risk of abuse, misuse, and diversion, opioids carry a number of health risks. Side effects from using opioids may include respiratory depression, confusion, tolerance, and physical dependence. For seniors, long-term use of prescription opioids also increases the likelihood of falls and fractures.
“For these reasons, it is essential that Medicare Part D beneficiaries only receive medically necessary opioids in the appropriate amounts,” the authors write.
In 2016, 1 out of every 3 beneficiaries received at least one prescription opioid through Medicare Part D. In total, 14.4 million of the 43.6 million beneficiaries enrolled in Medicare Part D received opioids. Above that, 501,008 beneficiaries received high amounts of opioids, not including beneficiaries who had cancer or were in hospice care.
In total, 115,851 prescribers ordered opioids for at least one beneficiary at serious risk of opioid misuse or overdose because the patient had received extreme amounts or appeared to be doctor shopping, or both. A total of 401 prescribers had “questionable prescribing patterns” by ordering opioids for the highest numbers of beneficiaries at serious risk.
“Prescribers must be vigilant about checking the state monitoring databases to ensure that their patients are receiving appropriate doses of opioids and to better coordinate patient care,” the authors write. “At the same time, we must address prescribers with questionable prescribing patterns for opioids to ensure Medicare Part D is not paying for unnecessary drugs that are being diverted for resale or recreational use.”
The agency also recommends both the public and private sectors strengthen public health surveillance, advance the practice of pain management, improve access to treatment and recovery services, target availability and distribution of overdose-reversing drugs, and support cutting-edge research.
“By working together and expanding our efforts in Part D, we can help curb the opioid crisis in our nation,” the authors conclude.
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Katie Kuehner-Hebert
Katie Kuehner-Hebert is a freelance writer based in Running Springs, Calif. She has more than three decades of journalism experience, with particular expertise in employee benefits and other human resource topics.
